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JOHN SHAW BILLINGS
AET. 58

detail of portrait by Cecilia Beaux
{National Library of Medicine)

SELECTED PAPERS

JOHN SHAW BILLINGS

Compiled, with a Life of Billings } by
FRANK BRADWAY ROGERS

MEDICAL LIBRARY ASSOCIATION
i965

Medical Library Association Publication No. 2

Free use of the material in this book, is granted, pro-
vided that acknowledgment of the source is made.

Library of Congress Catalog Card Number: 65-23107

Printed by the Waverly Press, Baltimore, Maryland

Contents

v Preface

1 The Life of John Shaw Billings

SELECTED PAPERS
14 Autobiographical Fragment
16 Memorandum

18 Letter of Transmittal, Specimen Fasciculus
2 1 Microscopical Memoranda, by Dr. Newlenz
24 A Century of American Medicine, 1776-1876; Litera-
ture and Institutions
76 Medical Libraries in the United States
90 The Medical Journals of the United States

1 1 5 Who Founded the National Medical Library?

116 Our Medical Literature

139 Address to the Graduating Class of Bellevue Hospital

Medical College
149 Medical Bibliography
170 Scientific Men and their Duties
190 Medicine in the United States
198 Methods of Research in Medical Literature

207 Hollerith Cards

208 Ideals of Medical Education

226 The Conditions and Prospects of the Library of the

Surgeon-General's Office
232 A Card Catalogue of Scientific Literature
235 The Card Catalogue of a Great Public Library
245 Address at the Dedication of the New Building of the

Boston Medical Library
249 Some Library Problems of Tomorrow
263 The Military Medical Officer at the Opening of the

Twentieth Century
270 Medical Reminiscences of the Civil War
275 Address Given at the Opening of the New Library

Building at Radcliffe College

285 Bibliography of the Writings of John Shaw Billings

Preface

One hundred years ago John Shaw Billings took over the direction of the
Library of the Surgeon-General's Office, U. S. Army. This book is issued in
celebration of that anniversary.

It has been a task at once easy and difficult to assemble these papers from
sources widely dispersed and often almost inaccessible to the reader of to-
day; easy, because the papers hold many things important for our own
time, and because I had available the five volumes of reprints bound in
turkey red, their paper now disintegrating, in the collection of the National
Library of Medicine; difficult, because the corpus from which the selection
was made is very large, and the winnowing-out process brought many
twinges of regret. In general, it will be evident that I have included mainly
the papers on medical bibliography, in which Billings' fame is most en-
during, and some papers in which the autobiographical element is promi-
nent. In addition, I could not resist the inclusion of "Scientific Men and
Their Duties" and "Ideals of Medical Education," which deal with more
general themes.

I have not presumed to edit Billings. Sometimes I have rearranged the
typographical format in what I conceive to be a way which facilitates easy
grasp of the data, as in the long lists of "Medical Journals of the United
States," but in the same article I have not altered the variant pattern of the
Ohio section — it is interesting evidence that, then as now, a man had to
rely on the contributions of his staff members. All articles are presented in
their entirety, except for minor deletions in "The Card Catalogue of a
Great Public Library," the excerpt on Hollerith cards, and the article on
"Medicine in the United States." This last is of some concern, for the arti-
cle had a large impact, and the effect, however undeserved, of turning
much criticism toward Billings; it is, however, full of maps and diagrams
and statistical matter which are unsuitable for reprinting in a book of this
sort.

In the bibliography of Billings' writings, originally prepared in 1915
by Miss Hasse for Garrison's memoir, I have corrected some errors, and
can only hope that in the process I have not created others, as in the course
of the extensive stylistic changes I have introduced. I have followed Miss
Hasse's practice in not listing the official publications of the Library of
the Surgeon-General's Office, under Billings' supervision, as part of the
Billings corpus, but serious students of his life should not forget the prefa-
tory and other materials to be found in the many volumes of the Index-

\ i

SELECTED PAPERS OF J. S. BILLINGS

Catalogue and the Index Medicus and in the Annual Report of the Sur-
geon-General, United States Army, for the Billings years.

When I conceived of this book at the beginning of 1957, I intended to
include the bibliography, and undertook some work on it, only to drop it
later as it began to appear that it might have to be sacrificed as a means of
keeping the book down to reasonable size. In the last months, at the urging
of the Publication Committee of the Medical Library Association, I have
again taken up the matter of bibliographical revision. For additions to the
bibliography I am particularly indebted to Dr. Dorothy M. Schullian, who
discovered and confirmed the attribution of many of the new items which
originally had been published anonymously; to Miss M. Ruth MacDonald,
who helped check against the Index-Catalogue, and in other ways; and to
Dr. Jean Curran. I also here record my indebtedness to colleagues in
Bethesda, Washington, New York, and London for their helpful assistance
in gathering material and in tracking down obscure bibliographical and
biographical points.

There are many repetitions in Billings' writings — favorite metaphors,
favorite stories, particularly felicitous ways of stating a problem — as one
might expect from a man who was in constant demand for the presentation
of public addresses. But the honest, straightforward, and easy style is al-
ways there, too, and reveals the man in all his great serenity of spirit.
Billings has much to teach us, and not only about bibliography.

In the preface to the last volume of the Index-Catalogue which he edited,
Billings described his efforts as a "labor of love." So has the compilation of
this work been for me, and I hope it will be of some usefulness as the
National Library of Medicine embarks upon its next hundred years.

Frank Bradway Rogers

Denver

University of Colorado Medical Center
14 March 1965

The Life of John Shaw Billings

Billings, John Shaw. b. April 12, 1838, son of James and Abby Shaw
Billings, in Cotton Township, Switzerland County, Indiana; moved to
Rhode Island in 1843, returned to Allensville, Indiana, in 1848. Bachelor of
Arts, Miami University, Oxford, Ohio, 1857. Doctor of Medicine, Medical
College of Ohio, Cincinnati, 1860; demonstrator of anatomy, 1860-61.
Entered Medical Corps, U. S. Army, 1861; 1st Lieutenant to Lieutenant-
Colonel; field service with Army of the Potomac. M. Katherine Mary
Stevens, September 3, 1862; c. Mary Clare, Kate Sherman, Jessie Ingram,
John Sedgwick, and Margaret Janeway B. Assigned Surgeon-General's
Office, Washington, December 31, 1864. Librarian, Library of the Surgeon-
General's Office, 1865-95. Professor of Hygiene, University of Pennsylvania,
Philadelphia, 1895-96. Director, New York Public Library, 1896-1913.
d. New York City, March 11, 1913.

The portrait of John Shaw Billings which hangs in the National Library
of Medicine shows him vested in the scarlet gown which he wore on the
occasion of receiving the degree of Doctor of Civil Law at Oxford in June
1889. At the time of receiving this honorary degree, Billings was fifty-one
years old, and for the moment was staying at the home of his friend, Sir
Henry Acland. In the afternoon, after the ceremonies, the Aclands took
Billings for a picnic on the river, carrying along a kettle and boiling tea
on the bank. Billings sat, tired and silent, until Acland's young daughter
insisted that Billings must tell the children a story. Billings promptly and
very solemnly began:

"A travelling showman, going around with a Biblical panorama, thus described one of
the pictures, 'This, ladies and gentlemen, is a picture of Daniel in the Lion's Den and —
you will be able to distinguish Daniel from the lions because he carries a green cotton
umbrella' " 1

It is a revealing incident. Billings was musing on the past, reflecting on
the long course of a lifetime which had led to a scarlet vestment and drink-
ing tea on the banks of the Cherwell. He was thinking of another summer,
32 years earlier, and another Oxford, in southwestern Ohio near the
Indiana border, where he had graduated second in his class from Miami
University in 1857. He was penniless and hoped to obtain employment as
a tutor so as to be able to pursue the study of medicine. Instead, he took

Address by Dr. Rogers at the National Library of Medicine, Bethesda, Maryland,
June 17, 1965.

1 Letter from Miss Acland to F. H. Garrison, quoted in Garrison's John Shaw Billings;
a memoir (New York, Putnam, 1915) p. 389.

LIFE OF J. S. BILLINGS

a job with an itinerant exhibitor of lantern slides and toured the midwest
delivering a rapid-fire running commentary on the startling scenes his em-
ployer flashed before an enthralled backwoods citizenry.

In 1858, at the age of twenty, he had matriculated at the Medical College
of Ohio, founded by Daniel Drake 40 years earlier in a booming Cincinnati
that was then the largest metropolis west of the Alleghanies. As Billings
later described it,

". . . I graduated in medicine in a two years' course of five months' lectures each, the lec-
tures being precisely the same for each year ... In those two years I did not attend the
systematic lectures very regularly. I found that by reading the textbooks, I could get
more in the same time and with very much less trouble. I practically lived in the dis-
secting room and in the clinics, and the very first lecture I ever heard was a clinical
lecture ..." 2

He lived in the hospital, cleaning out the dissecting rooms and doing all
sorts of odd jobs. At St. John's he was known to the nursing sisters as "St.
John of the Hospital," because of his melancholy mien and his austere
ways. The austerity was forced upon him by his financial condition; all
one winter he budgeted his food bills at 75 cents a week, which went largely
for milk and eggs.

He took his medical degree in 1860 and stayed on at the school as demon-
strator of anatomy, one of a faculty of nine. A newspaper advertisement
shows the fees for six months of lectures at the College, October through
February, as $105. Billings considered going into private practice with his
surgical professor, George Blackman, now remembered chiefly for his
re-editing of Mott's edition of Velpeau.

But at the end of that February of 1861 dark events were brewing.
Threats had been received against the life of the President-elect of the
United States; in Philadelphia he boarded the regular sleeper to Washing-
ton, and Pinkerton men sat with drawn revolvers in the dark berths to
either side of where he slept. Lincoln was inaugurated on March 4, and in
April the guns fired on Fort Sumter. It was Billings' twenty-third birthday.

He took the examination for admission to the Medical Corps of the
United States Army and passed first on the list. He served a preliminary
period as a contract surgeon, then was appointed First Lieutenant and
Assistant Surgeon in April 1862 and placed in charge of Cliffburne Hospital
in the old cavalry barracks on the hill above Georgetown. At the end of
August he was transferred to Philadelphia as executive officer of the hos-
pital there and, a few days later, was married to Miss Kate Stevens. At the
end of March 1863 he reported for duty to Dr. Jonathan Letterman,
Medical Director of the Army of the Potomac, then encamped near Fred-

Boston Medical and Surgical Journal 131: 140-2 (1894).

FRANK B. ROGERS

ericksburg. The Rappahannock river was crossed on April 28 and 29,
and Billings performed his first surgery in the field as Hooker engaged Lee
in the battle of Chancellorsville on May 2 and 3. Two months later he was
with the Second Division of the Fifth Corps at Gettysburg; Dr. Curran has
given us an account of how Billings established his regimental aid station
at the base of Round Top.3 Following the Draft Riots in New York City
later in July, Billings was sent to New York with the Seventh Infantry,
which pitched camp on Fifth Avenue just above Forty-ninth Street. He
was reassigned to hospital duty on Bedloe's Island in New York harbor,
and then in February 1864 was placed in charge of an extraordinary ex-
pedition to Haiti, to rescue 371 survivors of a group of freed slaves who
had been resettled there and swindled in the process. At the end of March
1864 he again joined the Army of the Potomac, still bogged down between
the Rapidan and the Rappahannock. As Medical Inspector for the Army,
he roamed a wide front and lived through the Wilderness and Spottsyl-
vania, Cold Harbor and the siege of Petersburg. By summer he was in-
valided back to Washington, and in the fall of 1864 was assigned for duty
at the Surgeon General's Office. His field service was over.

In the wonderful biography of Billings which Garrison has left us, there
is a long series of remarkable letters from Billings to his wife, covering in
a vivid way the period of his duties in the field. Of these we note two short
but typical fragments:

"July 9, 1863, Hospital near Gettysburg . . . PM. I am covered with blood and am tired out
almost completely, and can only say that I wish I was with you tonight and could lie
down and sleep for 16 hours without stopping. I have been operating all day long and
have got the chief part of the butchering done in a satisfactory manner . . ."

"April 17, 1864. Nothing new or important yet . . . Yesterday I went up to Culpeper, saw
Major Dent, who inquired very specially after you, was introduced by him to General
Grant and took dinner with the General and his staff. I like Genl. Grant. He is a thorough-
bred gentleman and suits me exactly . . ."

The war over, Billings settled down to a routine of office duties. Curi-
ously, he was worried at first that he would not have enough to do to
occupy his time; he began the study of German, as he had once studied
Latin and Greek as a boy, and undertook to teach himself something about
microscopical studies. A contemporary4 describes Billings' duties as "arid
drudgery among invoices and receipts, requisitions and bills of lading,
treasury drafts and auditor's decisions. His days were filled with routine
office work, with questions of bookkeeping and pecuniary responsibility,

a J. A. Curran, "Billings at Gettysburg." New England Journal of Medicine 269: 23-7
(1963).

4 Alfred A. Woodhull.

LIFE OF J. S. BILLINGS

with the supervision of checks and balances." He was detailed to the Secre-
tary of the Treasury in 1869-70 to inspect the condition of the Marine
Hospital Service, and prepared a reorganization plan which set that serv-
ice, later renamed the Public Health Service, on a new course. During the
period 1870-75 he prepared long reports on Army hospitals and Army
hygiene. He planned a new hospital for the Soldiers' Home in Washington,
he became active in the affairs of the American Public Health Association,
and was for a short time vice-president of the ill-starred and short-lived
National Board of Health. He was a founding member and later President
of the Cosmos Club and of the Philosophical Society of Washington. He
was elected a member of the National Academy of Sciences, and served as
its treasurer from 1887 to 1898.

The wonder is that in the midst of all these activities, his major task for
the 30 years from 1865 to 1895 was the direction of the Library of the
Surgeon General's Office. The Library, which had occupied a few shelves
behind the Surgeon General's desk since the days of Joseph Lovell and
Andrew Jackson, numbered about 1,800 volumes at the close of the War.
When Billings arrived, the man and the opportunity met. Years later, in
a commencement address at his old medical school, Billings described what
he had first envisioned in Cincinnati in 1860, while preparing his thesis
on the surgical treatment of epilepsy.

"In the thesis just referred to, it was desirable to give the statistics of the results ob-
tained from certain surgical operations as applied to the treatment of epilepsy. To find
these data in their original and authentic form required the consulting of many books,
and to get at these books I not only ransacked all the libraries, public and private, to
which I could get access in Cincinnati, but for those volumes not found here (and these
were the greater portion), search was made in Philadelphia, New York and elsewhere to
ascertain if they were in any accessible libraries in this country.

"After about six months of this sort of work and correspondence I became convinced of
three things. The first was, that it involves a vast amount of time and labour to search
through a thousand volumes of medical books and journals for items on a particular
subject, and that the indexes of such books and journals cannot always be relied on as
a guide to their contents. The second was, that there are, in existence somewhere, over
100,000 volumes of such medical books and journals, not counting pamphlets and re-
prints. And the third was, that while there was nowhere, in the world, a library which
contained all medical literature, there was not in the United States any fairly good
library, one in which a student might hope to find a large part of the literature relating
to any medical subject; and that if one wished to do good bibliographical work to verify
the references given by European medical writers, or to make reasonably sure that one
had before him all that had been seen or done by previous observers or experimenters
on a given subject, he must go to Europe and visit, not merely one, but several of the
great capital cities in order to accomplish his desire.

"It was this experience which led me when a favourable opportunity offered at the close
of the war, to try to establish, for the use of American physicians, a fairly complete
medical library, and in connection with this to prepare a comprehensive catalogue and
index which should spare medical teachers and writers the drudgery of consulting ten

FRANK B. ROGERS

thousand or more different indexes, or of turning over the leaves of as many volumes
to find the dozen or so references of which they might be in search."5

Billings had to acquire and train a staff, he had to obtain the books,
and he had to find housing for both. For a staff he had a dozen civilian
employees, many of them former army hospital stewards; only a single
member of the staff had had a college education. But they were dependable
and reliable, and Billings trained them in the rudiments of bibliographic
procedure for which at that time there were as yet no nationally accepted
standards. To get the books, exchanges were instituted with medical so-
cieties and institutions, begging letters were written to private individuals
at home and abroad, duplicates were amassed for subsequent swapping.
Wrappers were printed in two languages, English and Japanese, and sent
to Japan to facilitate mailing of journals from that newly opened country.
Billings sent one of his clerks to copy the list of journal titles which had
been compiled by Dr. Joseph M. Toner of Washington; he wrote to Dr.
Thomas Windsor of Manchester, instituting a series of exchanges and gifts
which were to form the backbone of the Library's historical collections;
he was constantly on the prowl in the libraries of his friends, as Oliver
Wendell Holmes and James R. Chadwick would later testify. He was lucky
enough to receive a fund of some $85,000, the proceeds of the sale of
properties left over from disbanded hospitals, and he used the money to
triple the collection. It was the lone instance of having money available
in any considerable amount; in later years the annual sums available to
Billings for operating the Library would reach $10,000.

In 1867 the Library found quarters in the old Ford Theatre building on
Tenth Street. That building of tragic memory, originally a Baptist church
before Mr. John T. Ford converted it for theatrical performances, had
been purchased by the government for official use. For a while Billings and
his staff remained at the Surgeon General's Office at Fifteenth Street and
Pennsylvania Avenue, where the books were accessioned and processed
before being carted over to Tenth Street. By 1880 the collections had
grown to such a size that the need for a new building was imperative. Bill-
ings organized an intensive building campaign. Congress was bombarded
by letters from physicians across the country; funds were appropriated in
1885; and the new building at the corner of Seventh Street and Independ-
ence Avenue was completed in the fall of 1887, at a cost of $200,000. The
ground floor of the building was occupied by a section of the Adjutant
General's Office; the east wing was occupied by the Army Medical Museum,
which had been formally placed under Billings' charge in 1883; and the
west wing with its four-tiered cast-iron bookstack was occupied by the
Library. From high clerestory windows the light filtered down through

'Cincinnati Lancet-Clinic 20: 297-305 (1888).

LIFE OF J. S. BILLINGS

stack floor gratings; on late winter afternoons the aid of a candle was
sometimes needed to find the books on the lower shelves of the first stack
level.

The growing collection had to be organized and cataloged. Small pam-
phlet catalogs had been printed in 1864 and 1865; the book catalog of 1868
lists over 6,000 volumes. The book catalog of 1872 ran to 431 pages, listed
over 13,000 volumes, and was provided with a subject index. The catalog
of 1873-74 was published in three volumes, and listed 50,000 titles of books
and pamphlets. Then, in 1876, the Specimen Fasciculus of a Catalogue of
the National Medical Library appeared. The title alone is noteworthy;
"National Medical Library" appeared prominently in 28-point type;
indeed, the letterheads of the Library during this period bore the same
legend. The Specimen set forth in dictionary order both books and periodi-
cal articles — the books listed by author and by subject, the periodical arti-
cles by subject only, in a single alphabet. On this plan, the first volume of
the Index-Catalogue of the Library of the Surgeon General's Office ap-
peared in 1880. The first series of the Index-Catalogue was to be completed
in 16 volumes, in the year of Billings' retirement.

The rise of the periodical form of publication of scientific literature had
been spectacular during the middle third of the nineteenth century. Bill-
ings recognized the importance of this new form and strove to cope with it.
He had clothesbaskets full of journals delivered to his home in Georgetown,
where he worked at night at the job of checking the items in each issue
which he wanted indexed. Returned to the Library, the journals were
processed by the Library clerks, who copied out the titles on cards which
measured 4*4 x6'/g inches. The next step sent the cards to Billings or to
his great assistant, Dr. Robert Fletcher, who had joined the staff in 1876;
they penciled a single appropriate subject rubric across the top of each
card, which was then filed to await its proper sequence in the publication
of the Index-Catalogue. Duplicate cards of current materials were made,
and these were published, beginning in 1879, in the monthly Index-Medi-
cus, for which the financial arrangements were handled on an extra-govern-
mental basis. Thus Billings provided a bibliographic service for current
awareness, along with another service designed primarily for retrospective
search.

With all this activity, reference services were not neglected. Billings and
his small staff somehow found the time to answer as many as two thousand
inquiries per year. Billings also instituted a forerunner of today's inter-
library loan system; physicians outside of Washington, on depositing
550.00, were allowed to borrow books from the Library, and the records
show that William Osier, Howard Kelly, William Halsted, Reginald Fitz,
Walter Reed, Rudolph Matas, and George Crile were among those who
took advantage of that privilege.

FRANK B. ROGERS

That Billings possessed extraordinary reserves of physical stamina, as
well as intellectual capacities, is shown by the fact that during this same
period, beginning in 1875, he was closely involved in the development of
the new Johns Hopkins Hospital and Medical School. Billings' plans were
chosen for the new hospital, which was begun in 1877 and opened in 1889.
No matter that those plans tolerated no elevator shafts, no matter that
they provided for thick coats of asphalt on the floors, in deference to the
still prevalent idea that foul miasmas arising from the soil should be pre-
vented from spreading, the plans represented a fresh new point of view
and a departure from the old block buildings or rambling wooden pa-
vilions of the past. And they embodied new ideas in medical education:
there was to be a separate out-patient dispensary, first-class physiological
and pathological laboratories, and a graded series of accommodations for
private patients. During this time Billings was the chief medical adviser
to Daniel Coit Gilman, the President of the new university. He arranged
the curriculum for the new school: he insisted that its purpose must be to
train investigators as well as practitioners; he was instrumental in bringing
in Welch and Osier as the nucleus of the first staff. He placed emphasis
on the keeping of proper records, financial and clinical; he taught courses
in the history of medicine, commuting back and forth from Baltimore to
Washington by train. He was giving his lectures on medical history else-
where, as well — in Boston, in New York, and on some of his numerous
trips abroad.

His interests in public health and vital statistics led to a position as con-
sultant for the tenth, eleventh, and twelfth U. S. Censuses between 1880
and 1912, and he published voluminous reports of his findings. He stressed
the necessity for morbidity as well as mortality statistics; he strove to get
agreement on a standardized classification for reporting purposes. Of
special interest to us of the present day, when the furor over machine
methods of bibliography is at a peak, is the fact that it was a suggestion of
Billings to Herman Hollerith, made over some chicken salad at Billings'
home, which led to the development of punched-card tabulation. As
Hollerith later wrote:

". . . and so it happened that one Sunday evening at Dr. B tea table he said to me there
ought to be a machine for doing the purely mechanical work of tabulating population
and similar statistics ... After studying the problem I went back to Dr. Billings and
said I thought I could work out a solution for the problem and asked him would he
go in with me. The Dr. said no he was not interested any further than to see some solu-
tion of the problem worked out."6

'Letter of August 7, 1919; quoted by J. Fraser Muirhead in his article "Doctors afield;
John Shaw Billings," New England Journal of Medicine 268: 778-9 (1963). See also
Frederick J. Rex, Jr., "Herman Hollerith, the first 'statistical engineer'." Computers and
Automation, August 1961, pp. 10-3 [with an important bibliography of Hollerith].

LIFE OF J. S. BILLINGS

He went abroad often, buying books, visiting medical military installa-
tions, speaking at medical convocations, representing his country. His ad-
dress at the International Medical Congress in London in 1881 was an
enormous success and drew world-wide attention to the problems of a grow-
ing medical literature and to medical bibliography. In 1886 he was invited
to speak before the British Medical Association, and his frank address on
the state of American medicine, kindly and humorous and forthright
though it was, drew some criticisms in this country and some disapproba-
tion from organized medicine that did not abate for many years thereafter.

In 1895, after 30 years' service at the Library, President Cleveland
granted his retirement from the Army, and he accepted a post as Professor
of Hygiene at the University of Pennsylvania, at the insistence of his old
friend, William Pepper, whom he had advised for some years. It was not
an entirely happy move; Billings was a public health man of the old school,
the statistician and the sanitary engineer, and did not feel too much at
home in the direction of the type of laboratory investigations then becom-
ing prominent. He attracted capable people, however, and gave them their
heads. At the end of November 1895 a great banquet was held in Billings'
honor in Philadelphia, and the medical community turned out in force.
The toastmaster on this occasion was Billings' old friend, Weir Mitchell;
Osier and DaCosta and Jacobi and Chadwick and Fletcher were there, and
spoke of Billings' achievement. Osier read a message of congratulations
from Surgeon General Sternberg, and announced that Billings' portrait
was to be painted and presented to the Library. Billings was given a silver
box, and inside it was a check for $10,000, which had been subscribed by
friends in England and the United States.7 Billings responded in his usual
eloquent fashion, and was magnanimous in his praise of his colleagues.
It must have been in many ways a tense situation for Billings, newly ar-
rived in Philadelphia and under obligation to the University of Pennsyl-
vania, for he had been told only three days before the banquet that he had
been selected as the Director of the New York Public Library, then newly
forming from an amalgamation of the Astor, Tilden, and Lenox libraries.
Somehow he managed to work things out with Pepper; Weir Mitchell
helped to smooth the way; and at the end of summer in 1896, after three
months in Europe to attend the Royal Society's International Conference
on Scientific Literature and study continental libraries, Billings moved to
New York, there to spend the remaining 17 years of his life.

Billings set to work. He brought the Tilden books into the Lenox build-
ing and set up some two miles of temporary wooden shelving in the Astor

'"Banquet and presentation in honor of John Shaw Billings, M.D., LL.D.," Medical
News (Phila) 67: 634-41 (7 Dec 1895).

FRANK B. ROGERS

building. He installed artificial lighting in both buildings. He drew up a
scheme of classification of which he remarked that

". . . it is not a copy of any classification used elsewhere; that it is not specially original;
that it is not logical so far as the succession of different departments in relation to the
operations of the human mind is concerned; that it is not recommended for any other
library, and that no librarian of any other library would approve of it . . ."

He tried to reconcile the varying styles of cataloging, and brought in a
system which was much like that of the Index-Catalogue, with periodical
articles carded among the books. He successfully bargained with City
officials and the State legislature for a building site on the land occupied
by the old Croton reservoir at Fifth Avenue and Forty-Second Street. An
architectural competition for the new building was held, plans were com-
pleted on the basis of rough pencil sketches which Billings had drawn up
one day in Atlantic City in 1897, and the building was begun. The corner-
stone was laid in 1902, and nine years later, in May 1911, the new building
was opened to the public. The staff was reorganized; the collections grew
from almost half a million volumes in 1901 to over a million volumes in
1913, while the 42 branch libraries which Billings established held another
million volumes.

As usual, his extracurricular activities threatened to outstrip his more
regular efforts. In 1902 he served as President of the American Library
Association; between 1905 and 1908 he was engaged in drawing up plans
for the Peter Bent Brigham Hospital in Boston, which he had the satis-
faction of seeing completed in 1913; and from the founding of the Carnegie
Institution of Washington in 1902 he served as a member of the Executive
Committee, and from 1903 on as Chairman of the Board of Trustees.

In his last years, he had days when he preferred to keep to himself. Near
the end he said to his deputy, "I no longer have any enthusiasm. I have ac-
quired a tendency to oppose new things and new ideas." He was sometimes
irascible with his colleagues in the councils of the Carnegie Institution.
" Walcott," he once said, "I seem to oppose everything, don't I?" The reply
was "No . . . but you are sometimes cross and intractable." The death of
his wife in August 1912 was a severe blow. That she was a constant in-
spiration to him throughout his life, no one can doubt who has read his
letters. The man who could be so tough and so brusque at times was also
the man who could write to her in salutation: "Idle of my Sole." He was
the same man who could tell stories about Daniel in the Lions' Den to a
little girl on a picnic.

During his last years he was frequently unwell. He had had five opera-
tions for facial cancer between 1890 and 1892, the last performed by Dr.
William S. Halsted and involving a radical neck dissection. He was

LIFE OF J. S. BILLINGS

troubled with renal and biliary calculi; in 1900 he was operated on by Dr.
Charles McBurney, and in 1906 a cholecystectomy was performed. In 1913
he underwent another operation, pneumonia supervened, and he died on
March 11, in his seventy-fifth year, one week after the inauguration of
President Wilson. He was buried in Arlington National Cemetery.

In his seventy-five years, he had fought a war, had revolutionized hospital
construction, had been a prime mover in public hygiene and sanitation,
had played a leading role in the development of vital statistics, had chal-
lenged the medical profession to higher levels of accomplishment, had done
more to advance American medical education than any other individual
of his generation, had created a great national medical library and built
for it bibliographical keys of comparable magnitude. He was a mover and
shaker; he had organizing genius and the passion for doing. He had vision,
managerial adroitness, and a dogged and relentless power of will. Once
he had said to the Librarian of the Royal Society of Medicine: "I'll let
you into a secret — there's nothing really difficult if you only begin — some
people contemplate a task until it looms so big, it seems impossible, but
I just begin and it gets done somehow. There would be no coral islands
if the first bug sat down and began to wonder how the job was to be done." 8

Billings was singularly fortunate in his biographers. Fielding H. Garri-
son, who had joined the staff of the Surgeon General's Library in 1891,
brought out his remarkable memoir in 1915; Harry Miller Lydenberg,
Billings' protege and later successor as Director of the New York Public
Library, prepared a shorter evaluation in 1924 to inaugurate the ALA
series on American Library Pioneers. In what follows I borrow many of
their words and phrases, adding some emphasis of my own.

Billings was a tall figure of powerful build and commanding appearance.
He was austere and somewhat distant in manner, and did not suffer fools
gladly; he was a man of imperious judgments, and much inclined to have
his own way. He was fertile in ideas, straightforward in expression, and
entirely wrapped up in accomplishing whatever he set out to do. (Garrison)
He knew what the master word in medicine is, he knew the glory of the
day's work, he had the rare gift of industry of the minute. He seized upon
essentials, and sometimes left behind some baffling small details that
plagued his followers. He was impatient of committees and committee
work; in striking out ahead of the crowd, he sometimes lost sight of the
fact that those who moved in his wake frequently gained by their efforts
at standardization and cooperation, however plodding they might be. He
had unshakeable confidence in his own judgment; he formed his own
opinions and drew his own deductions. He was constantly drawn on into

8 J. V. W. MacAlister, British Medical Journal 1: 642 (1913).

FRANK B. ROGERS

new directions; rarely did he re-examine the purely technical solutions he
devised so readily and well.

Through all his activities, through all periods of his life, stands out,
pre-eminent and persistent, his love of books. He read wherever he was
and whatever he was doing. At sea or on land, at home or away, in the city
or in the country, his book and his cigar were his constant companions.
(Lydenberg)

He had a strong temper, usually well under control. As reticent in praise
as in reproof, the weight of either was unmistakable when he did express
it. The army officer was apparent in countless ways, in what he expected
as well as what he did. The medical man and the scientist appeared with
equal frequency, in his attitude to life, in the way he faced the great prob-
lems of nature, in his scrupulously careful weighing of evidence, in his
methods of attacking new problems. (Lydenberg)

William Welch said that John Billings was the wisest man he ever knew.
He was that rare thing in modern life, an absolutely reliable man. (Garri-
son) Loyalty to friends and ideals, wideness of sympathy and vision, tenac-
ity of purpose, ceaseless industry, consideration of others before himself,
gentleness combined with firmness — these were the outstanding character-
istics of this soldier, scholar, physician, librarian, (Lydenberg) this alto-
gether remarkable man who dominated the American medical scene for
almost half a century.

Bibliographical Note
The sources of information on Billings' life are pre-eminently:

Fielding H. Garrison, John Shaw Billings, a Memoir. New York, Putnam, 1915. 432 p.
[with a genealogy of the Billings family, the military record of JSB, and a bibliog-
raphy of the writings of JSB].
Harry Miller Lydenberg, John Shaw Billifigs; Creator of the National Medical Library
and Its Catalogue; First Director of the New York Public Library. Chicago, American
Library Association, 1924. 95 p. [American Library Pioneers, I].
National Academy of Sciences. Biographical Memoirs. Washington, 1917. Vol. 8.

"Biographical memoir of John Shaw Billings," by S. Weir Mitchell, pp. 375-83. [Pub-
lished also in Science 38: 827-33 (Dec. 12, 1913)].
"The scientific work of John Shaw Billings," by Fielding H. Garrison, pp. 385-416.
Fielding H. Garrison, "Billings; a Maker of American Medicine," in Lectures on the
History of Medicine, . . . 1926-1932. Philadelphia, W. B. Saunders Company. [Lecture
given before Northwestern University Medical School, Chicago, November 8, 1928;
and before the Mayo Foundation, Rochester, November 14, 1928].
"In memoriam; John Shaw Billings." Index Medicus March, 1913. [4 p.].
"John Shaw Billings; an appreciation." Military Surgeon 61: 61-4 (1927).
"Greetings from the Surgeon-General's Library." Colorado Medicine 13: 366-8 (1916).
Alfred A. Woodhull, "Lieut.-Col. John Shaw Billings, U. S. Army." Journal of the Mili-
tary Service Institution 53: 328-42 (1913).

LIFE OF J. S. BILLINGS

Bulletin of the New York Public Library, vol. 17, 1913.

pp. 511-30. Memorial meeting in honor of the late Dr. John Shaw Billings, April 2j,
1913. [Addresses by Weir Mitchell, Wm. Osier, Wm. H. Welch, Andrew Carnegie,
Richard B. Bowker, John L. Cadwalader].

pp. 531-3. Appendix [Letters from Cardinal Farley, Sir Henry Burdett, E. C. Richard-
son, Helen E. Haines, Cressy L. Wilbur].

pp. 534-5. Minute adopted by the American Library Association at its annual con-
ference at Kaaterskill, New York, June 25, 1913; John Shaw Billings, April 12, 1838-
March 11, 1913.

[an account of this meeting appears also in Library Journal 38: 334-8 (June 1913)].
Jean A. Curran, "John Shaw Billings, medical genius of the 19th century." Bulletin of
the Medical Library Association 42: 163-71 (1954). [contains information on manu-
script sources].

H. M. Hurd, "Dr. John Shaw Billings, bibliographer and librarian." Bulletin of the

Medical Library Association 5: 35-40 (1915-16).
C. C. McCulloch, "The Surgeon-General's Library." Bulletin of the Medical Library

Association 6: 25-39 (1916-17).
W. F. Willcox, "The past and future development of vital statistics in the United States.

I. John Shaw Billings and federal vital statistics." Journal of the American Statistical

Association 21: 257-66 (1926).
"John Shaw Billings Memorial Number," Bulletin of the Institute of the History of

Medicine, April, 1938 (Vol. 6, No. 4).
Introduction. Henry E. Sigerist. pp. 223-4.

John Shaw Billings as an Army medical officer; a tribute on his hundredth birthday,
April 12, 1938. Edgar Erskine Hume. pp. 225-70.

John Shaw Billings and the Johns Hopkins Medical School; a tribute on the one
hundredth anniversary of his birth. Alan M. Chesney. pp. 271-84.

Two papers by John Shaw Billings on medical education; with a foreword by Alan M.
Chesney. pp. 285-359.

John Shaw Billings and the history of medicine. Sanford V. Larkey. pp. 360-76.

John Shaw Billings and the New York Public Library. H. M. Lydenberg. pp. 377-86.
Raymond Pearl, "Some notes on the contributions of Dr. John Shaw Billings to the de-
velopment of vital statistics." Bulletin of the Institute of the History of Medicine
6: 387-93 (1938).

"Two letters by John Shaw Billings on the history of medicine," with a foreword by
Sanford V. Larkey. Bulletin of the Institute of the History of Medicine 6: 394-8
(1938).

Prominent among the many obituaries are:

[Sir Henry Burdett], Hospital (London) 53: 671-3 (March 22, 1913).
J. Y. W. MacAlister, British Medical Journal 1: 642 (March 22, 1913).
Sir Lauder Brunton, British Medical Journal 1: 642 (March 22, 1913).

Nature 91: 62 (March 20, 1913).
Sir William Osier, British Medical Journal 1: 641 (March 22, 1913).
Albert Allemann, Miinchener Medizinische Wochenschrift 60: 1096 (May 20, 1913).
Bulletin of the New York Public Library 17: 307-12 (1913).
Journal of the American Medical Association 60: 846 (1913).

J. Ewing Mears, Transactions of the American Surgical Association 31: xxxiv-xxxix
(1913).

FRANK B. ROGERS

For general background, see the following:

John F. Fulton, The Great Medical Bibliographers; a Study in Humanism. Philadelphia,
University of Pennsylvania Press, 1951. ["John Shaw Billings," pp. 67-75].

Estelle Brodman, The Development of Medical Bibliography. Medical Library Associa-
tion, 1954. ["John Shaw Billings," pp. 105-27].

For history of the National Library of Medicine, see:

Dorothy M. Schullian and Frank B. Rogers, "The National Library of Medicine."

Library Quarterly 28: 1-17, 95-121 (1958).
Dorothy M. Schullian, "Thomas Windsor, benefactor of the Army Medical Library."

Bulletin of the Medical Library Association 38: 135^4 (1950).
Dorothy M. Schullian, "Unfolded out of the folds." Bulletin of the Medical Library

Association 40: 135-43 (1952).
Dorothy M. Schullian, "Alfred Alexander Woodhull, John Shaw Billings, and the Johns
Hopkins Hospital, 8 June 1871." Journal of the History of Medicine and Allied
Science 13: 531-7 (1958).
Harold W. Jones, "The Army Medical Library; its history and its future obligations."

Journal of the American Medical Association 122: 1074-9 (1943).
Richard Hood, "The Army Medical Library." Science 105: 422-6 (April 25, 1947).
Scott Adams, "The Army Medical Library and other medical libraries of the nation."

College and Research Libraries 9: 126-32 (April 1948).
"Army Medical Library Number," Medical Life, December, 1936. (Vol. 43, No. 12).
The centenary of the Army Medical Library. H. W. Jones, pp. 533^13.
The oration commemorating the 100"1 anniversary of the founding of the Army Medi-
cal Library, Washington. Sir Humphrey Rolleston. pp. 543-62.
The greetings from beyond the seas. H. W. Jones, pp. 563-73.
A greenhorn's experience in the library. Percy M. Ashburn. pp. 573-9.
Dr. Billings and his work. Albert Allemann. pp. 587-90.

[The first three articles were also published in Military Surgeon 80: 1-31 (Jan. 1937)].
Edgar Erskine Hume, "Buildings for the Army Medical Library," Military Surgeon 80:
45-52 (Jan. 1937).

Frank B. Rogers and Scott Adams, "The Army Medical Library's Publication Program."

Texas Reports on Biology and Medicine 8: 271-300 (1950).
"National Library of Medicine Anniversary Issue." Bulletin of the Medical Library

Association, July, 1961. (Vol. 49, No. 3).
Memoir of Robert Fletcher. Estelle Brodman. pp. 251-90.
The survey and after. Janet Doe. pp. 361-8.
Reminiscences. Mary Louise Marshall, pp. 369-73.
Housing the library.

Part I. The old building. Keyes D. Metcalf. pp. 396-402.

Part II. The new building. Walter H. Kilham, Jr. pp. 403-10.
Comprehensive collecting, then and now. Leslie K. Falk and Samuel Lazerow. pp.

434-42.

Adams Jewett and John Shaw Billings, partners in acquisition. Dorothy M. Schullian.
pp. 443-9.

Autobiographical Fragment

I first got a realizing sense of my own personality or individuality when,
a boy about eight years old, I was at work on a hillside on the farm of
Tristram Burgers, near Providence, R. I. My father was the manager of this
farm, and my business that sunny afternoon was to chop up and dig out by
the roots all the Canada thistles I could find in the pasture.

I had read the Bible through — verse by verse, also Robinson Crusoe,
Deerslayer, Pathfinder, and Pilgrim's Progress — but I had never done any
thinking that I can remember. But on this memorable afternoon, I stood
on the hillside and looked over Narragansett Bay, and wondered where
all the catboats and schooners with their white sails came from, and were
going to. Then my thoughts took this turn: "The only person who can
know that is God. He knows everything that has been, and is, and is to be.
Then, hundreds and thousands of years ago, He knew that I should be here
today, and that each of those boats would be just where it is, and that I
should be thinking of them. Then, as His knowledge must have been per-
fect, it is absolutely necessary that I, just as I am, knowing just what I
know, am here at this moment, looking at these ships, which also must be
just where they are. Then everything must be arranged and ordered to be
just as it is, and no one can prevent it. Therefore, I am not responsible for
where I am nor for what I do." I was surprised at this conclusion, and
thought I had made a great discovery, and resolved to tell my mother about
it when she was worrying about our troubles. I did tell her about it that
night, and said that there was no use in worrying any more. She looked at
me in a scornful sort of way, and said, "Who's been teaching you about
foreordination." "Nobody taught me," said I. "I found it out by myself —
don't you see it must be so?"

My life on the Burgers' farm, from about five to ten years of age, was that
of an ordinary farmer's boy. I dropped four or five grains of sweet corn in
the proper place in the furrow in planting time, I helped weed the little
carrots and young beets, rode the horse for horse-raking the hay crop, went
to a country school for three months in the winter, made little clam-bakes
along the shore with my cousins William Henry and Charles Shaw, and
read everything I could lay hands on. I managed to get a dollar for sub-
scription to a little lending library in a book shop, and the first books I

As printed on pp. 2-A of Fielding H. Garrison's John Shaw Billings; a memoir (New
York, Putnam, 1915). Garrison says that Billings wrote this slight sketch "at the instance
of his friends a few years before his death."

AUTOBIOGRAPHICAL FRAGMENT

took out were Deerslayer, Pathfinder, and Jock o' the Mill. I had for my
own, Robinson Crusoe, Marco Paul in the Forests of Maine, Harry and
Lucy, and Plutarch's Lives, and was quite sure that I did not want to be a
farmer.

When I was about ten years old, my father moved to Indiana and estab-
lished himself in a little crossroads village called Allensville, on the road
from Rising Sun to Vevay. Here he kept a country store — was postmaster,
and had a small shoemaker's shop in which one man was employed. I
learned something of shoemaking — had some experiences in keeping
store. I read incessantly. Came across a book — I have forgotten its title —
which had a number of Latin quotations in it, asked a young clergyman
(John C. Bonham) how I could learn Latin — and got a Latin grammar and
reader — a copy of Ccesar, and a Latin dictionary, and set to work. It was
difficult, but with the aid of Mr. Bonham I made good progress. Then I
made an agreement with my father that if he would help me through col-
lege in the least expensive way, all of his property should go to my sister,
and that I must expect nothing more. I then got some Greek books, a
geometry, etc., and went on to fit myself to pass the entrance examination
for the sub-freshman class at Miami University, Oxford, Ohio. I succeeded
in doing this in a year — and passed the examination in the fall of 1852.
For the first two years I kept bachelor's hall, living on bread, milk, potatoes,
eggs, ham, etc., such things as I could cook for myself. The lessons gave me
little trouble. Most of my time was spent in reading the books in the College
Library. I was omnivorous, read everything in English as it came, phi-
losophy, theology, natural science, history, travels, and fiction.

Memorandum

The Library of the Surgeon General's Office may be said to date from
the late war, at the commencement of which it consisted of about 350
volumes of text-books and journals.

In October, 1865, as appears by a pamphlet catalogue of that date, the
number of volumes was about 1,800, and since that time the increase by
donation, exchange, and purchase has been steady and rapid; the present
catalogue containing about 13,000 titles, including 13,300 volumes.

The object kept in view in the formation of the Library has been to
obtain publications relating to —

1. Military hygiene, medicine, and surgery.

2. Public hygiene, medical police, and state medicine, including epi-
demics and quarantine.

3. Vital and medical statistics.

4. Medical and scientific journals and periodical literature.

5. Chemistry, meteorology, and physics.

As will be seen by the catalogue, a good foundation has been made for
a library relating to the above subjects; but it is still very far from being
complete.

That there is need in this country of a medical library of this character
is sufficiently evident from the fact that, in all the public medical libraries
of the United States put together, it would not be possible to verify from
the original authorities the references given by standard English or German
authors, such as Hennen, Reynolds, or Virchow. No complete collection
of American medical literature is in existence; and the most complete, if
in this country, is in private hands, and not accessible to the public; while
every year adds to the difficulty of forming such a collection as the Govern-
ment should possess. The books are now safely and conveniently arranged
in the fire-proof building of the Army Medical Museum, and are accessible
to the public under rules and regulations essentially the same as those for
the Library of Congress.

It, in fact, forms a highly desirable, and, indeed, necessary supplement
to the Congressional Library, and is catalogued in the same manner, the
principle being to give a literal transcript of the title-page of each work,
omitting titles of authors.

Prefaced to Catalogue of the Library of the Surgeon General's Office, United States
Army; with an alphabetical index of subjects. Washington, Government Printing Office
1872.

MEMORANDUM

The alphabetical index of subjects is not intended to be complete. It in-
cludes only works readily classified, and subjects relating to which two or
more works are in the Library.

Prepared and printed within six months, to meet a want which daily
became more pressing, errors have been inevitable, especially those of
omission. It is hoped that a corrected and much enlarged edition will be
needed and can be prepared within a very few years.

Letter of Transmittal, Specimen Fasciculus

War Department, Surgeon-General's Office,
Washington, D. C, February 1, 1876.

General: I have the honor to submit the following specimen of a cata-
logue of what may now be properly called the National Medical Library,
heretofore known as the Library of the Surgeon-General's Office.

The entire catalogue, of which this is a sample, is nearly ready for the
press, and it is hoped and believed that it will be found of practical interest
and value in a bibliographical point of view as well as for the immediate
use of the collection to which it relates.

A few copies of this specimen have been printed in order to show the
character and scope of the collection, to obtain criticisms and suggestions
as to the form of catalogue which will be most acceptable and useful, and
to furnish data for the decision as to whether it is desirable that such a work
should be printed and distributed.

The specimen submitted is of a combined catalogue of subjects and au-
thors, arranged in dictionary order under a single alphabet.

The first question to be decided is whether this form is preferable to
two separate works, one containing the authors and the other the subjects.
Having consulted some of the principal medical writers and teachers of
this country, for whose use and benefit the work is intended, and after
conference with some of the librarians of largest experience, the weight of
opinions in favor of the single-alphabet system for this particular work has
appeared sufficiently marked to warrant its employment in this specimen.

The next question is with regard to the classification adopted, which is
mainly from the anatomical standpoint. By the use of numerous cross-
references, it has been made certain, as far as possible, that the titles desired
can be found, although not always under the heading anticipated; for in
this respect it is impossible to meet the wishes of all without excessive
duplication.

The references are always from the general to the more special heads;
thus, under "Abdomen (Tumors of)", attention is directed to "Aneurism
(Aortic)", etc. An attempt has been made by the use of varieties of type to
make it as easy as possible to catch the particular title desired; but there is
still room for improvement in this respect, since some of the "sorts" de-
sired were not available. If the printing of the entire work should be au-
thorized, it is hoped that the most desirable form will be used.

Letter of transmittal, Specimen fasciculus of a catalogue of the National Medical
Library, under the direction of the Surgeon-General, United States Army. Washington
1876. pp. iii-vi.

SPECIMEN FASCICULUS

Titles printed in the larger type, or brevier, are of books and pamphlets.
Those given under authors give the collation of the book and the name of
the publisher.

In the titles under subject-headings, the names of authors are in italics,
to the end of the subject of "Abscess", after which, for purposes of com-
parison, they are in brevier small-capitals; the titles are as brief as possible,
and collation and name of publishers are omitted. Some variations in type
and mode of setting are also made, for the purpose of obtaining opinions
as to the relative merit of the several styles.

In the small type, or nonpareil, are given references to articles in jour-
nals, transactions, and collections. These include the results of the ex-
amination of about 5,000 volumes of such publications. This work is still
going on; and, by the time the catalogue is sent to press, it is hoped that
it will be completed.

Although this is only the catalogue of a single library, and that of so
recent formation as to forbid anything like completeness, an attempt has
been made to prepare, as far as time and materials would allow, a work
of practical usefulness for bibliographical purposes to all physicians, even
if they have not access to the library itself. It makes no pretensions to be-
ing a complete medical bibliography, and should not be estimated as such;
it is rather a foundation, and an outline which each must complete for
his own specialty.

All medical writers know that the most valuable part of medical litera-
ture consists of the records of cases and original observations, and that,
for the present century, the greater part of such records are contained in
periodical publications. These are difficult to obtain and preserve, occupy
a large amount of space, and, even when accessible, require much time and
labor to consult. It is not very difficult, although rather expensive, for a
physician who is interested in a particular subject to obtain all the really
important monographs relating to it; but that which he cannot obtain, and
which he must look to large public libraries to supply, are the journals and
transactions containing the most valuable data for his purpose.

Special effort has therefore been made to complete the files of medical
periodicals in this collection, and with very good success; although there are
still some important gaps in this department, which should be filled, and
the indexing completed as far as possible, before the final publication of
the work.

For the information of those not already familiar with the scope and
character of the library, its present condition may be briefly stated as fol-
lows:

It is the National Medical Library of this country, being essentially
the Medical section of the Library of Congress; its general plan of man-
agement and of cataloguing being the same. It is at present under the

JOHN SHAW BILLINGS

direction of the Surgeon-General of the Army, in connection with the
Army or National Medical Museum. For several years, the Librarian of
Congress has not purchased medical books, leaving that branch of litera-
ture to be collected by this department. The library now contains about
40,000 volumes, properly so called, and about the same number of single
pamphlets.

Large as this number may appear to those who are not familiar with
the amount of literature on this subject, it is only about one-half what
such a collection should contain in order to place the writers of this coun-
try in such a position as regards means of reference to the literature of
medicine as it is desirable that they should command.

Hardly a day, and never a week, goes by that a request is not made of
the librarian for some medical book which the library does not possess.

The use which is made of the collection by physicians from every sec-
tion of this country, and the number of persons who consult it, either in
person or by letter, is steadily, and of late rapidly, increasing; and I can-
not doubt that if a sufficient number of the catalogue, of which this is a
specimen, be printed, and distributed to our medical writers and teachers,
so that they may at their leisure learn what aid they can obtain in their
researches, no collection of the Government will be more used or be of
more practical utility; that it will soon tend to elevate the standard of medi-
cal education, literature, and scholarship of the nation, and will thus in-
directly be for the benefit of the whole country, since the general knowledge
and skill of the medical profession become a matter of personal interest to
almost every individual at some time during the course of his life.

For these reasons, and for others which will readily suggest themselves,
it has appeared to me to be the duty as well as the privilege of the National
Government to make this collection of the literature of medicine as com-
plete as possible, and to provide a catalogue of it of such a kind as would
be of most practical working value.

With this end in view, the following specimen is submitted, not as be-
ing a satisfactory solution of the problem, for no one knows better than
myself the imperfections of the work, but as a foundation, and, in some
sense, an indication, of what it is hoped the library and its catalogue may
one day be made.

The complete catalogue on the present plan would make five volumes
of about one thousand pages each.

Very respectfully, your obedient servant,

John S. Billings,

General Joseph K. Barnes,

Surgeon-General U.S.A.

Assistant Surgeon U.S.A.

Microscopical Memoranda

BY DR. NEWLENZ

At the close of the late war, having been brevetted lieutenant-colonel,
through the untiring efforts of the member from my district, and being
therefore desirous of contributing to the reputation and usefulness of
some of the learned societies, I applied for admission to the Royal Mi-
croscopical Society, among others. National jealousy, probably, caused the
rejection of my application, and the result was that I formed a society
myself. This society has devoted itself exclusively and earnestly to his-
tology, pathology, test-objects, the cryptogamic origin of disease, spontane-
ous generation, germinal matter, bacteria, and cells1 in general.

Having constructed a one-seventieth immersion objective, on a new
principle, having 191° aperture, — the immersion liquid being fluoric acid,
— and, for illumination, having invented a new eccentric parallelopiped,
to be used with fluorescent rays exclusively, some remarkable results have
been obtained.

I take great pleasure in stating that, with regard to test-objects, all pre-
vious observers have been totally wrong in every particular, and that
Pleurosigma angulatum is, in the first place, constructed on the plan of the
Nicholson pavement, and, in the second place, that it is not a Pleurosigma
at all.

The most certain test-object is the Newlenzia difficilissima, a very rare
and remarkable diatom, in which my one-seventieth with the parallelo-
piped shows four kinds of beads and six sets of cross-lines, one of which
sets contains 147,229,073 lines to the inch: hence, by the well-known for-
mula of Brewster,

d- x /

JTU = Vo-x-p-y,

it is impossible that the undulations of light should pass without being
previously deflagrated, and therefore no other lens can possibly show these
lines, nor is it probable that this lens would with any other observer. The
immense superiority of this test to Nobert's plate is apparent.

Reserving this topic for future discussion, I have a few words to say
with regard to spontaneous generation and cryptogams. With regard to

Medical Times (Phila) 1: 200 (1 Mar 1871) [Correspondence].
xSic, — not sells.

22 JOHN SHAW BILLINGS

the former, the true theory was declared in 1740, in "Lucina sine Concu-
bitu,"— a most valuable and rare work, which seems to have been over-
looked by recent writers on this subject. The author, starting from the
proposition of the ancient philosophers, "Non potest reperiri avesne vel
ante ova generata sint, cum et ovum sine avi, et avis sine ovo gigni non
possit," proceeds thus: "Je n'h&itai done plus a regarder ce vent . . . comme

le vehicule propre pour ces embrions flottans Sur ces principes, je vms

a bout de fabriquer une machine,— Cilindrico-catoptrico-rotundo-concavo-

convex Cette machine fut lutee hermetiquement d'une terre electrisee,

et je le placai dans une position convenable vers l'Occident pour inter-

cepter les animalcules flottans dans cette partie prolifique du ciel Je

decouvris clairement que ces germes £toient des petites femmes et des petits
hommes exacts dans leurs membres."

It will be seen that the machine above referred to prefigured the aero-
scope of Pouchet, the isolation apparatus of Hallier, and several other
modern inventions. One American and one English observer seem to have
entered fully into the spirit of the above-mentioned work; and I desire
to offer to them the assurance of my unbounded admiration for the power
of their faith and the vigor of their imagination.

The following experiments, conceived in the spirit of their method, will
be found interesting:

Exp. 1. — A glass flask was filled with ditch-water, and boiled three days
in a Papin's digester, under a pressure of four atmospheres. After a week
it was opened, and in the first drop of the contents was found the re-
markable animal shown in the accompanying sketch.2

Bacteria were abundant.

Exp. 2. — Some of the fluid contents of an ovarian tumor (a remarkable
case, removed by myself through the perineum, of which I shall give a
full account in my report to the American Medical Association on Perine-
otomy) was examined by fluorescent light. It was full of spontaneously-
generated corpuscles, starch-fibres, and cotton granules, with many in-
visible germs.

Exp. 3. — Two ounces of water, containing, among other things, Ge-
miasma, Euglena, Podura nivalis, Micrococcus, Cryptococcus, Arthrococ-
cus, and an entirely new and original coccus, — viz., Newlenziacoccus, —
were drunk, by mistake, by a friend of the author. For twenty-four hours
he was afflicted with a conglomerated epidemic which presented nearly
every symptom described in Da Costa's Manual. Cryptogamismus is the
only appropriate term for his condition.

My most remarkable discoveries, however, have been in the blood. Space

2 The sketch is necessarily omitted. It looks remarkably like Pediculus capitis. Ed.

MICROSCOPICAL MEMORANDA

is wanting to enumerate here the many forms of Coccus, Algae, and Rhizo-
pods that I have found in the blood, when the proper conditions of obser-
vation were afforded.

I can only say here, in conclusion, to the numerous persons who have
written to me on this subject, that a minute investigation with the one-
seventieth and the parallelopiped requires much labor. I always give at
least an hour to each specimen; and, as I have had to examine over twenty
thousand specimens within the last year, I am compelled to state that, in
future, unless fifty dollars are sent with the drop of blood on which I am
to furnish diagnosis and treatment, I shall not notice it.

Immersion Hall, February 2, 1870.

A Century of American Medicine
1776-1876

Literature and Institutions.

"Wherefore, by their fruits ye shall know them."
Besides his duties to his patients, the physician is under certain obli-
gations to contribute, by way of interest, his quota to the common stock
of medical knowledge from which he has drawn so freely. The skilful
diagnosis, judicious medication, or bold and successful operation, if not
properly recorded, benefit the individual only, not being available for
those comparisons and higher generalizations which alone can make medi-
cine a science. By the manner in which this duty, of preserving and trans-
mitting the results of its labour and experience, has been performed, the
medical profession of a country, as well as the individual physician, must
to a great degree be judged, and the question now presented is, to what
extent and in what manner have the physicians in the United States ful-
filled this part of their professional obligations during the century just
passed.

In the retrospective reviews, historical sketches, and centennial ad-
dresses which have, during the past year, been devoted to American medi-
cine, our most important contributions to the healing art have been duly
pointed out, and for the most part sufficiently eulogized. That the United
States has a medical literature, has been cumulatively demonstrated, even
to the extent of raising a suspicion of the existence of a doubt upon this
point; and that this literature contains many valuable original contribu-
tions to the art, if not to the science, of medicine may be considered as
unanimously affirmed and admitted.

If the defects of which all are more or less aware, have been but
slightly referred to, it is because the purpose of the writers has been
rather eulogistic than critical. In this final article of the present series,
the object is not to select for praise the best of the work, nor the reverse,
but to endeavour to give an idea of the quantity and value of the whole
of it. So far as individual writers are concerned, an attempt will be made
to supplement the information given in previous papers, but these have

American Journal of the Medical Sciences 72: 439-80 (1876). [The fourth and final
article of a series which appeared under the general title "A Century of American
Medicine, 1776-1876;" earlier articles were by E. H. Clarke (Practical Medicine), H. J
Bigelow (Anesthesia), and T. G. Thomas (Obstetrics and Gynecology).]

CENTURY OF AMERICAN MEDICINE

been so complete as regards that which is worthy of notice, that little
need be said of single books and articles.

We will first endeavour to give some account of the quantity of medi-
cal literature produced in the United States during the last hundred
years; making use for the purpose of some statistics obtained from a
nearly complete list of the medical books published in this country from
1776 to the present time, and from which it may be considered certain
that no important work has been omitted.

In these statistics we do not include works intended for the non-medi-
cal public, those relating to "ics" or "pathies," nor the great mass of
what are called pamphlets in the technical sense of the word, that is,
books of less than one hundred pages. The great majority of these pam-
phlets are either reprints from periodicals, addresses inaugural or valedic-
tory, a few of which contain historical data of interest, or controversial
and personal disquisitions which are best forgotten. While it is true that
there is no necessary connection between the size of a work and its prac-
tical or scientific value, it will be found that with a very few exceptions,
which have been pointed out in the preceding articles of this series,
nothing of interest or importance is omitted by this division. The books
to be counted may be classified as follows: —

I. Systematic treatises and monographs by physicians residing in this
country, including reports of hospitals, corporations, and gov-
ernment departments.
II. Reprints and translations of foreign medical books.

III. Medical journals.

IV. Transactions of medical societies.

The first, third and fourth classes include what is ordinarily meant by
the phrase "American Medical Literature." From them are excluded books
written by American authors, but printed abroad, as, for instance, those
of Dr. Wm. Charles Wells; while on the other hand, they include books
written by physicians born and educated abroad, but who may be said to
have become citizens of this country, such as Tytler, Pascalis, Busche,
Dunglison, Jacobi, and Knapp.

The statistics of the four classes above given, include not only the medi-
cal literature of the United States for the century, but nearly all which the
country has produced since the first settlement. At the commencement of
the Revolutionary War, we had one medical book by an American author,
three reprints, and about twenty pamphlets. The book referred to is the
"Plain, Precise, Practical Remarks on the Treatment of Wounds and
Fractures," by Dr. John Jones, New York, 1775. It is simply a compilation
from Ranby, Pott, and others, and contains but one original observation,
viz., a case of trephining followed by hernia cerebri.

JOHN SHAW BILLINGS

The libraries of our physicians were composed, according to Bartlett,1
of the works of Boerhaave, with the Commentaries of Van Swieten, the
Physiology of Haller, the Anatomy of Cowper, Keil, Douglass, Cheselden,
Monroe, and Winslow; the Surgery of Heister, Sharp, Le Dran, and Pott;
the Midwifery of Smellie; the Materia Medica of Lewis; and the works of
Sydenham, Whytt, Mead, Brookes, and Huxham. The works of Cullen
were just beginning to be known. The only public medical library was that
of the Pennsylvania Hospital, which contained, perhaps, two hundred and
fifty volumes. There were probably not two hundred graduates of medi-
cine in the country, and not over three hundred and fifty practitioners of
medicine who had received a liberal education. Two medical schools had
just begun, but had accomplished little previous to the war which closed
them, there were no medical journals, and but one State Medical Society,
that of New Jersey, had been organized. From this unpromising condition
of things, have been developed the literary results, of which we now pre-
sent a summary.

It will be seen from Table I, that the medical literature of the United
States really commences with the present century, and this is still more
apparent, if the character of the works issued prior to 1800, be considered.

The first literary contributions of our physicians, after the close of the
war, are contained in the memoirs of the American Academy of Arts and
Sciences, Boston, 1785, and in the Transactions of the American Philo-
sophical Society at Philadelphia, 1786. The first original separate work
was the "Cases and Observations by the Medical Society of New Haven
County, in the State of Connecticut," New Haven, 86 pp. 8vo., 1788. This
is a collection of twenty-six articles, including several cases and autopsies
of interest, and a paper on the production of dysentery among troops by
overcrowding and foul air, in which the connection of cause and effect is
clearly demonstrated.

The majority of the succeeding publications, to the end of the century,
related to the yellow fever, which was then epidemic along the whole
Atlantic coast. The most prominent author of this period is Benjamin
Rush, noteworthy also as an orator and politician. His writings excel in
manner rather than matter, and the undoubted influence which he exerted
over the earliest stages of American medicine, was probably due to his lec-
tures rather than his published works. The best of his essays, and indeed
the only one to-day worth consulting, is that on diseases of the mind, which
contains some original observations of interest. One of his eulogists, Dr.
Ramsay,2 says: "On the correctness of this opinion [viz., his fondness for

*A Dissertation on the Progress of Medical Science in the Commonwealth of Massa-
chusetts, Boston, 8vo., 1810.

2Eulogium upon Benjamin Rush, by David Ramsay, Philadelphia, 1813, 8vo., pp 79

CENTURY OF AMERICAN MEDICINE

TABLE I

Table Showing Number of Medical Books Printed in the United States
from January 1, 1776, to January 1, 1876

1775
to

1799

1800
to
1809

1810
to

1819

1820
to

1829

1830
to

1839

1840
to
1849

1850
to
1859

I860
to

1869

1870
to

1875

Total

t_jlass 1. American .Medical .dooks

No. 1st edition

^o
oy

A O

101

157

130

729

i > \j • i cut i cuiiiuiio

14.
It

1 7
1 /

*ty

oil

A A

QOC

ooo

1NO. vois. x otai

136

162

197

256

180

1176

Class II. Reprints and Translations

1 pHitinn

9ft

FA.

79
1 Z

ito

1 oo

1 C\A
1U'+

7K7

/o/

No. later editions

1 i
1 1

0*2

388

ino. vois i otai

A O

111
111

IOC

1 03

19z

214

184

160

137

1274

Class III. Medical Journals

No. Journs. com'ced

195

" " discont'd

137

"A." Original

No. Vols, com'need

104

173

376

292

296

1376

No. Vols, compl'ted

166

366

271

283

1312

"B." Reprints

No. Journals

No. Volumes

258

Class IV. Transactions Med. Societies

No. Volumes

111

336

the use of the lancet] his fame as an improver of medicine in a great degree
must eventually rest." And to the correctness of this judgment we entirely
assent.

The work of James Tytler3 is a good compilation, and contains, among
other data not to be found elsewhere, an interesting letter by Dr. John
Warren, of Boston. Tytler was born in Scotland in 1747, came to this
country about 1796, and was drowned in 1804; he possessed extensive and
varied learning, and wrote much, but for the most part on non-medical
subjects.

The works of Noah Webster,4 though mainly historical, are still of
interest, and worth preservation.

Another writer of this period is Dr. William Curry, a native of Penn-
sylvania, 1755-1829. At first educated for the church, he acquired an

8 A Treatise on the Plague and Yellow Fever, with an Appendix. 8vo., 1799.

4 A Collection of Papers on the subject of Bilious Fevers, prevalent in the United
States for a few years past. 246 pp. 8vo. New York, 1796. A Brief History of Epidemic and
Pestilential Diseases; with the principal Phenomena of the Physical World which pre-
cede and accompany them, and Observations deduced from the facts stated. 2 vols., 8vo.,
Hartford, 1799.

JOHN SHAW BILLINGS

excellent knowledge of Latin and Greek, and studied medicine under Dr.
Kearsley, of Philadelphia. During the Revolutionary War he served as
surgeon in the American army, being attached to the military hospital on
Long Island, in 1776. After the war, he at first settled at Chester, but
removed to Philadelphia about 1791. He was one of the original fellows of
the College of Physicians of Philadelphia, and for many years a member
of the Board of Health. His principal works in addition to his numerous
pamphlets and articles on yellow fever, are his "Historical Account of the
Climates and Diseases of the United States," 1792; and his "View of the
Diseases most Prevalent in the United States," Philadelphia, 1811.

Towards the close of the century, and for a few years thereafter, there
were published in Boston, New York, and Philadelphia, a number of medi-
cal theses, which, being classed as pamphlets, are not taken into account
in our statistics, and are noticed here for the sake of saying a word with
regard to this class of medical literature. A medical dissertation prepared,
not for the press, but simply as a formality necessary for the obtaining of
a diploma, as is the case with nearly all those which have been presented
at our medical schools for the last fifty years, fairly merits the denunciation
of Professor Gross, "that not one in fifty affords the slightest evidence of
competency, proficiency, or ability, in the candidate for graduation."

Such was not the case, however, with regard to the theses above referred
to, nor can it be justly said with regard to any series of printed theses of
the European schools. It would seem, therefore, that when prepared as
they should be, with reference to the probable criticisms, not merely of a
single professor, but of the press and the public, there is the strongest
inducement to refrain from plagiarism, and to produce the best work of
which the candidate is capable; and it is well known to those who have
had frequent occasion to consult them, that collections of printed medical
theses are valuable, as historical documents, presenting a reflex of the
teachings of the school, and as containing accounts of cases and original
investigations, or particular doctrines of the student's preceptor, which
cannot be found elsewhere. The proportion of copied matter, vague spec-
ulations, and other rubbish, does not, upon the whole, appear to be so
much greater in this than in some other classes of medical literature, as to
warrant their wholesale condemnation; and the remedy for the present
unsatisfactory character of the theses of our medical students, appears not
to be their abolition, but the requiring that they shall be printed, and con-
sidered as an important and real test of the merit of the candidate. They
should of course be written in the vernacular. The influence which a
teacher has in directing the thoughts of his pupils, is very well shown in
the theses of the Philadelphia school, a considerable number of which re-
lated to medical botany, under the stimulus given by Dr. Barton to that
branch of study.

CENTURY OF AMERICAN MEDICINE

During this period, and prior to the establishment of any medical
journal, or regular publication of the transactions of any medical society,
a number of communications from American physicians were sent to so-
cieties in Europe, and appear in their transactions. Perhaps the most nota-
ble paper of this kind was "An Experimental Inquiry into the Properties
of Opium," by John Leigh of Virginia, which obtained the Harveian prize
for 1785, and was printed at Edinburgh in the following year. It is worth
consultation, not only for the facts which it records, but for the method of
investigation pursued, which was unusual in that day of theories.5

From the year 1800 to the present time, the above table shows that
there has been a steady increase in the amount of our indigenous medical
literature, corresponding in the main to our increase in population and
wealth. To obtain some notion of the quality and value of this production,
a more detailed analysis is necessary.

The greater part of these books are compends relating to the treatment
of diseases and injuries. Those which have been most popular, and are the
best known, are the text-books and systematic treatises. These are for the
most part compilations, but their importance is by no means to be under-
estimated, for the practice of the majority of the physicians of this country
to-day, is based on the text-books of the teachers in the New York and
Philadelphia schools. Also we must remember that "there are compilations
and compilations." The preparation of such systematic treatises as those of
Flint, Gross, Stille\ and Wood, does not require less labour or thought, or
give less scope for display of genius, than the so-called original monographs.

Writers of this class bring into their proper relations the isolated facts
and observations scattered through many books, give them the mint stamp
of value, and put them into general circulation.

For reasons already stated, and for want of space, but few books can
here be noticed, even by title, and in connection with these will be given
some very brief biographical data relating to a few authors. Of living
writers and their works, as little as possible will be said.

In Anatomy our principal systematic works have been produced by
Wistar, Horner, Morton, Richardson, Agnew, Hodges, Leidy, and Smith.
None of them are now of interest. Dr. Caspar Wistar, 1761-1818, was of
German descent, and a native of Philadelphia. Having obtained a good
classical education, he studied medicine under Dr. John Redman, and took
the degree of Bachelor of Medicine, in 1782. He continued his studies at
Edinburgh, where he graduated M.D. in 1786. Returning to Philadelphia,

6 In this connection also may be mentioned a rare and little known work, being the
oration delivered at the University of Virginia in 1782, by J. F. Coste, the Medical Di-
rector of the French Forces. Its subject is "Antiqua novum orbem decet medico philo-
sophia;" it is dedicated to Washington, of whom the author was a personal friend, and
makes a volume of 103 pages, 8vo.; printed at Leyden, in 1783.

JOHN SHAW BILLINGS

he became Adjunct Professor of Anatomy in 1791, and continued to lec-
ture until his death. His System of Anatomy was issued in parts, 1811-
1814, making two volumes, and was a popular text-book for a long time.

The first work issued by Dr. Horner was a Dissector's Manual, in 1823.
This was followed by his treatise on General and Special Anatomy in 1826,
his Anatomical Atlas, and treatise on General and Special Histology.

A good original work has yet to be written on this last subject, in this
country. In surgical anatomy, Drs. Anderson and Darrach have produced
partial treatises, the first on the groin, pelvis, and perineum, New York,
1822; the second on the anatomy of the groin, Philadelphia, 1830.

Drs. N. R. Smith, Goddard, and Neill, have each issued a work on the
Surgical Anatomy of the Arteries. Among the few original works in this
department, should be mentioned those of Dr. John D. Godman, a native
of Annapolis, Md., 1794-1830. Poor and almost friendless, but urged on
by an unquenchable thirst for knowledge, he persisted in obtaining an
education in spite of the greatest difficulties and discouragements, and at
last took the degree of M.D. at the University of Maryland in 1818.

In 1821 he went to Cincinnati to accept a chair in the Medical College
of Ohio, but dissensions in the faculty induced his speedy resignation. He
then established a medical journal hereafter to be alluded to, but in 1822
went to Philadelphia and began a course of private lectures in anatomy.
In 1826 he accepted the chair of Anatomy in Rutgers College in New
York, but failing health soon compelled him to cease teaching, although
he continued to use his pen until just before his death. Dr. Godman was
an anatomist by nature, and though the necessities of bread-winning pre-
vented him from accomplishing any great work, his treatise on the fascia6
and his contributions to physiological and pathological anatomy7 are really
original and valuable productions.

The papers of Dr. John Dean on the "Microscopic Anatomy of the
Lumbar Enlargement of the Spinal Cord," Cambridge, 1861, and on
"The Gray Substance of the Medulla Oblongata," published by the Smith-
sonian Institution in 1864, are the results of careful work, and are note-
worthy for the use made of photo-lithography from micro-photographs to
obtain the illustrations.

The craniological works of Drs. Morton and J. A. Meigs should be
referred to here. Dr. Samuel George Morton, 1799-1851, was a native of
Philadelphia, and graduated in medicine at the University of Pennsylvania
in 1820, after which he continued his studies for three years at Edinburgh,

6 Anatomical Investigations, comprising Descriptions of Various Fasciae of the Human
Body, 8vo., Philadelphia, 1824.

7 Contributions to Physiological and Pathological Anatomy, 8vo., Philadelphia, 1825

CENTURY OF AMERICAN MEDICINE

obtaining his degree in 1823. From 1839 to 1843 he was Professor of Anat-
omy in the Pennsylvania Medical College. His fame rests upon his "Crania
Americana," Philadelphia, 1839, and his "Crania Egyptiaca," ibid., 1844;
works which have a world-wide reputation, and whose value is permanent.
His labours in this direction have been continued by Dr. J. Aitken Meigs,
whose "Catalogue of Crania," Philadelphia, 1857, is well known to all who
are interested in this subject.

In physiology, our text-books have been the works of Dunglison, Draper,
Dalton, and Flint, all too well known to require more than a mere refer-
ence. The work of Professor Draper, published in 1853, was the first in this
country in which micro-photographs were used to obtain illustrations. To
these may be added the works of Reese, Oliver, Goadby, and Paine. Of
special treatises and essays, the most important are Beaumont's Experi-
ments on Digestion, Plattsburgh, 1833; Draper "On the Forces which
produce the Organization of Plants," New York, 1844; Joseph Jones' "In-
vestigations," published by the Smithsonian in 1856; S. W. Mitchell's "Re-
searches upon the Venom of the Rattlesnake," idem, 1860; and Hammond's
"Physiological Memoirs," Philadelphia, 1863. In this department Brown-
Sequard may be claimed as an American author; some of his researches
having been made, and the results first published in this country. Those
who are familiar with the literature of thirty years ago will remember with
a smile, the treatise of Emma Willard on the circulation of the blood, and
the controversies to which it gave rise. The "Essays on the Secretory and
the Excito-Secretory System of Nerves," by Dr. H. F. Campbell of Georgia,
Philadelphia, 1857, should be remembered in this connection, as also the
pamphlets of Dr. Dowler of New Orleans.

In the department of Materia Medica and Therapeutics, we have made
a good record. In Medical Botany, the works of B. S. Barton and Jacob
Bigelow deserve especial mention as works of permanent value. The
"Illustrations of Medical Botany," edited by Dr. Carson, Philadelphia,
1847, containing one hundred plates, in folio, is a rare and costly work, a
considerable part of the edition having been destroyed by fire.

The first systematic treatise on Materia Medica and Therapeutics, pro-
duced in this country, was that of Dr. Chapman, Philadelphia, 1817. This
was followed by the works of Eberle, J. B. Beck, Dunglison, Harrison,
G. B. Wood, T. D. Mitchell, Biddle, Stille, Riley, and H. C. Wood, all of
which have been, or are popular text-books in the schools.

The majority of these authors will be referred to under other sections,
but of three, a few words may here be said. Dr. John P. Harrison was born
in Louisville in 1796; studied under Dr. Chapman, and graduated in medi-
cine in 1819. He was Professor of Materia Medica in the Cincinnati Col-
lege from 1836 to 1839. In 1841 he accepted the same chair in the Medical

JOHN SHAW BILLINGS

College of Ohio, in 1847 was transferred to that of Theory and Practice,
and died of cholera in 1849. He was one of the editors of the Western
Journal of Medicine, and of the Western Lancet; published a collection
of his essays in 1835, and his "Elements of Materia Medica and Thera-
peutics" in 1846.

The principal work on Materia Medica is the "United States Dispen-
satory" of Wood and Bache. Dr. Franklin Bache was born in Philadelphia
in 1792, and died in 1864. Graduating as Bachelor of Arts in 1810, he
studied under Dr. Rush, and obtained his medical degree in 1814. His
tastes led him to the special study of chemistry, of which branch he was
appointed professor in the Franklin Institute, in 1826. In 1841 he accepted
the same chair in the Jefferson School. His principal work was in connec-
tion with the United States Pharmacopceia and the Dispensatory, which
have made his name familiar to every physician in the United States. The
first proposal to form a Pharmacopceia in this country was made to the
College of Physicians of Philadelphia, in 1787, with the result of the ap-
pointment of a committee, which seems to have continued about ten years,
but effected nothing. In 1808 a Pharmacopceia was published by the Massa-
chusetts Medical Society, and in 1816 another was issued by the New York
Hospital. Our present national Pharmacopceia originated in a plan sub-
mitted to the New York County Medical Society, in 1817, by Dr. Lyman
Spalding. A leading part in the formation of the first edition, by the con-
vention which met in Washington in 1820 for that purpose, was taken by
the College of Physicians of Philadelphia, through its delegates, and more
especially by Dr. Thomas T. Hewson; and in the subsequent revisions,
Drs. Hewson, Bache, and Wood were the principal workers. The first re-
vision, adopted in 1830, was entirely the production of these gentlemen,
and was substantially a new work. The Dispensatory was projected by Drs.
Wood and Bache as an exposition of the Pharmacopceia, and a means
of making it more popular.

The exposition has, so far as our physicians are concerned, entirely
overshadowed the text, and in a financial point of view, the Dispensatory is
the most successful medical book ever published in this country.

Among writers on Materia Medica, distinguished in their day, may be
mentioned Dr. William Tully, 1785-1859, who graduated at Yale in 1806,
and attended medical lectures at Dartmouth College in 1808-9. He re-
ceived the honorary degree of M.D. from Yale in 1819. In 1824, he was
appointed Professor of Theory and Practice in the Castleton School, and
in 1826 removed to Albany, forming a partnership with Dr. Alden March.
In 1829, he accepted the chair of Materia Medica and Therapeutics at
Yale, and removed to New Haven, but continued his lectures in Castleton
until 1838. He ceased teaching in 1841. His principal works were the "Es-
says on Fevers," published with those of Dr. Miner, 1823, a work which

CENTURY OF AMERICAN MEDICINE

gave rise to much controversy, and was, upon the whole, not favourably
received; a prize essay upon Sanguinaria, published in the American Medi-
cal Recorder in 1828; some papers in the Boston Medical Journal; and
finally, his treatise entitled "Materia Medica, or Pharmacology and Thera-
peutics," Springfield, 1857-58, in two large volumes 8vo. This was pub-
lished in numbers, was not a popular work, nor calculated for the use of
a student, but shows great industry and learning in every page. Complete
copies of it are not now easily obtained, although it cannot be said to be
rare. His style is discursive, diffuse, and polysyllabic, and a decided effort
is necessary to peruse his writings; but his knowledge of facts was minute
and exact, and his last work is a mine of information, which is even now
worth exploring by the curious.

In surgery, our indigenous text-books have been produced by Dorsey,
Gibson, S. D. Gross, Ashhurst, and Hamilton. On Operative Surgery we
have the treatises of Pancoast, Piper, H. H. Smith, Stephen Smith, and
Packard. The posthumous work of McClellan is not a systematic treatise,
but a series of essays and cases, in which the description of Shock is espe-
cially noteworthy as being true to life. Of monographs, the most valuable
are those by Professor Gross, on Wounds of the Intestines, 1838; on Dis-
eases of the Bladder, 1851-55; on Foreign Bodies in the Air-passages, 1854
and 1862; and Diseases of the Bones and Joints, 1830; F. H. Hamilton on
Fractures and Dislocations, 1860, fifth edition, 1875; Durkee and Bumstead
on Venereal; Van Buren and Keyes, and Gouley on the Urinary Organs;
Bushe on Diseases of the Rectum; Carnochan on Congenital Dislocations
of the Head of the Femur; H. J. Bigelow on the Mechanism of Dislocation
and Fracture of the Hip; Ashhurst on Injuries of the Spine; Markoe on
Diseases of the Bones; and Garretson's Oral Surgery. Specially valuable
collections of cases, are the works of John C. Warren, on Tumors, Boston,
1837; and of J. Mason Warren; the pamphlets of Sayre on Orthopaedic
Surgery; N. R. Smith on Fractures of the Lower Extremity; and J. C. Nott,
"Contributions to Bone and Nerve Surgery." As an example of careful
statistical work, the treatise of R. M. Hodges on "The Excision of Joints,"
Boston, 1861, is to be specially commended.

The treatise of Dr. Gross, on Wounds of the Intestines, above referred
to, first appeared in the "Western Journal of Medicine;" it contains the
results of numerous experiments and observations, and is of much prac-
tical value and interest. It is a rare book, and a copy of it may properly
be considered a prize by the collector.

In Military Medicine and Surgery nothing of value was produced by the
revolutionary war, the war of 1812, or the war with Mexico. This deficiency
has been, to a great extent, made up by the number and value of works
resulting from our late war.

The Medical and Surgical History of the War will be, when completed,

JOHN SHAW BILLINGS

the largest medical work ever produced in this country. The publications
of the Sanitary Commission, including the works of Flint, Gould, and
Lidell, contain valuable data. The manuals of military surgery have been
written by Gross, Hamilton, Tripler, Blackman, Chisholm, and Warren.
Other works which should be remembered in this connection are, Wood-
ward on Camp Diseases, the statistical reports and circulars issued from
the Surgeon General's Office, and the medical statistics of the Provost-
Marshal General's Office, compiled by Dr. Baxter, making two handsome
quarto volumes, which are a most valuable addition to our knowldge of
anthropometry and medical topography.

In the departments of Theory and Practice of Medicine, we have pro-
duced a fair amount of monographs and text-books, the most important
of the latter class being those of Chapman, Eberle, G. B. Wood, and Flint.
The following is a brief outline of the lives of a few who were our principal
writers and teachers in this branch of medicine, but who now rest from
their labours. Among them, there are few, who, in their day, had a more
extended reputation, or were more popular than Dr. Nathaniel Chapman.

Born in Virginia in 1780, he received an excellent general education,
became a pupil of Dr. Rush, with whom he was a favourite, graduated
at the University in 1800, then spent three years in Europe, one as a pupil
of Abernethy, and two at Edinburgh, and in 1813 was elected to the chair
of Materia Medica in his Alma Mater, to be exchanged in 1816 for that of
the Theory and Practice of Medicine, which he held until 1850, when he
resigned. He died in 1853. His "Therapeutics and Materia Medica," pub-
lished in 1817, was the best work of the kind in English at that date. He
was the first President of the American Medical Association after its per-
manent organization; President of the American Philosophical Society, a
popular lecturer, a genial companion, and in his prime probably the most
distinguished physician in the United States. He edited, for seven years, the
Philadelphia Journal of the Medical and Physical Sciences. Many of his
lectures were published in the "Medical Examiner," in 1838-40. Two vol-
umes of these lectures were published in 1844, and a compendium of his
course on theory and practice was issued in 1846.

Contemporary with Dr. Chapman, and for twenty-five years associated
with him as a teacher, was Dr. Samuel Jackson, 1787-1872, a native of
Philadelphia, and educated in the University of Pennsylvania, having
graduated in medicine in 1808. From 1825 to 1863, he was Professor of the
Institutes of Medicine in his Alma Mater. His "Principles of Medicine"
(Philadelphia, 1832, 8vo.) was a treatise on pathology, founded on the doc-
trines of Broussais, and received high praise in its day. It was also the sub-
ject of a long and acrimonious critical review by Dr. Caldwell. The popular
story that Dr. Jackson recalled all the copies of this work that he could is

CENTURY OF AMERICAN MEDICINE

incorrect; the entire edition was sold in the usual manner, and the pub-
lishers desired to issue another, but the author refused, on the ground that
the science was undergoing such rapid and great changes that he would
feel it necessary to re-write the entire work, a labour which his health and
the demands of his private practice would not allow him to undertake.
His most important writings are contained in the American Journal of the
Medical Sciences, the last being a paper on a rare disease of the joints, in
the July Number for 1870.

Dr. John Eberle, 1788-1838, was of German descent, and a native of
Pennsylvania. After graduating in medicine in 1809, he went into politics,
edited a newspaper, acquired intemperate habits, and became a bankrupt.
Commencing life again, in 1825 he took the chair of Theory and Practice
in the Jefferson School, which he held until 1831, when he removed to Cin-
cinnati, and became connected with the Faculty of the Medical College of
Ohio. In 1837, he removed to Lexington, Ky., to accept a chair in the
Transylvania School, but could not lecture, and soon died. His treatise on
the Practice of Medicine, first published in 1829, was, in its day, a very
popular work, in part at least because of the formulae which it contained,
but is now forgotten.

Dr. Elisha Bartlett, born in Rhode Island in 1804, died 1855, graduated
in medicine at Brown University in 1826, after which he spent a year in
Paris. He held Professorships at Woodstock, Vt., Pittsfield, Mass., Dart-
mouth, Baltimore, Lexington, Louisville, and finally, in 1850, in the Uni-
versity of the City of New York. Of the numerous productions of his pen,
the most noteworthy are the "Inquiry into the Degree of Certainty in
Medicine," etc., Philadelphia, 1848; "The History, Diagnosis, and Treat-
ment of Typhoid and Typhus Fever," Philadelphia, 1842; and, "The His-
tory, Diagnosis, and Treatment of the Fevers of the United States," Phila-
delphia, 1847; of which, three subsequent editions were issued. To these
may be added his essay on the Philosophy of Medical Science, in which
the importance of facts and observations is insisted on, and all theorizing
is denounced, in accordance with the teachings of Louis.

Dr. David Hosack, 1769-1835, a native of New York, graduated as
Bachelor of Arts at Princeton in 1789, and as Doctor of Medicine in the
University of Pennsylvania in 1791. After practising a year at Alexandria,
Va., he spent two years in Edinburgh and London. Returning to New York,
he entered into partnership with Dr. Samuel Bard, was appointed Pro-
fessor of Botany in Columbia College in 1795, to which was added the chair
of Materia Medica, in 1797. In 1807, he was chosen Professor of Surgery
and Midwifery in the newly-formed College of Physicians and Surgeons of
the State of New York, and in 1813, took the chair of Theory and Practice.
In 1826, he resigned, with others, and went into the Rutgers Medical

JOHN SHAW BILLINGS

College. His writings appear in the philosophical transactions, in the
"Medical and Philosophical Register," of which he was the founder, and
as occasional lectures and pamphlets. They were collected and published
as "Essays on various subjects in Medical Science," in three volumes, New
York, 1824-1830. His "System of Nosology" reached two editions; his "Lec-
tures on Theory and Practice" were edited by Dr. Ducachet, and published
at Philadelphia in 1838. His most important paper was his "Observations
on Febrile Contagion," and on the means of improving the Medical Police
of the City of New York, N. Y., 1820. As a lecturer, editor, and writer, he
exercised much influence on the profession, and his literary and scholarly
tastes were imparted to his pupils, and especially to Dr. John W. Francis,
who, after his graduation in 1810, became associated with him in practice.
Dr. Francis was the son of a German grocer, born in New York, 1789, died
1861. He was for thirteen years Professor in the College of Physicians and
Surgeons, and followed Dr. Hosack to Rutgers, the close of which ended
his career as a teacher.

Dr. Joseph Mather Smith, 1789-1866, graduated at the College of Physi-
cians and Surgeons in 1815, and was Professor of Theory and Practice of
Physic, same school, 1826 to 1855, when he took the chair of Materia
Medica. He contributed largely to literature through the medical journals;
presented some interesting reports to the American Medical Association,
and published "Elements of Etiology," a "Philosophy of Epidemics," New
York, 223 pages, 8vo.

For beauty of style as a writer and lecturer, Dr. Samuel Henry Dickson
is pre-eminent. Born in Charleston in 1798, he graduated at Yale in 1814,
and in Medicine at the University of Pennsylvania in 1819; was Professor
in the Charleston Medical School from 1824 to 1831, 1833-34, 1850-7; in
the New York University, 1847-50; and in the Jefferson School, 1858; he
died March 31, 1872. His systematic works were not very successful, or
worthy of special remark, but his journal contributions, and especially his
volumes of essays, are among the most attractive literature of medicine.

John K. Mitchell, born in Virginia, 1793, took his academical degrees
at the University of Edinburgh, commenced his medical studies under Dr.
Chapman in 1816, and graduated in medicine at the University of Penn-
sylvania in 1819. After three voyages to India and China, for the sake of
his health, he returned to Philadelphia, and in 1822, began to deliver lec-
tures on Medical Chemistry in the Summer School. In 1841, he was elected
to the chair of the Practice of Medicine in the Jefferson Medical College,
which he filled to the date of his death in 1858. As an original investigator,
and clear logical reasoner, his name stands among the highest, and is prob-
ably destined to a higher relative position in the future, than it enjoys even
now. His papers on Endosmosis, Mesmerism, Ligature of Limbs for Spasm,

CENTURY OF AMERICAN MEDICINE

and Cryptogamous Origin of Fevers, will be consulted, not only for the
original facts which they set forth, but as models of suggestiveness, if the
phrase may be permitted.

Dr. Charles Frick, born at Baltimore August 8, 1823, received the degree
of Doctor of Medicine from the University of Maryland in 1845. In 1856,
he was chosen to the chair of Materia Medica in the Maryland College of
Pharmacy, and in 1858, he became Professor of Materia Medica and Ther-
apeutics in the University of Maryland. His most valuable contributions
to literature are his "Analysis of the Blood," American Journal of the
Medical Sciences, January, 1848; "Treatise on Renal Diseases," 1850; "On
Diabetes," American Journal of the Medical Sciences, 1852; "On Urinary
Calculi," American Medical Monthly, April, 1858. He died March 25,
1860, of Diphtheria, contracted from a patient upon whom he had per-
formed the operation of Tracheotomy five days previous. All his papers
are careful, conscientious reports of original observations, with the least
possible amount of theory, and with direct reference to practice.

Among the diseases which have received the greatest amount of atten-
tion in this country may be mentioned yellow and malarial fevers, and
diseases of the chest. Our literature on yellow fever includes over one
hundred books and pamphlets, besides more than six hundred journal
articles. It was the epidemic of this disease along the North Atlantic coast
which gave the first impetus to medical authorship in this country, and
produced a mass of controversial writings which, although of little value
in a scientific point of view, were useful, as giving their authors the habit
of writing for the press. The earlier books have already been referred to,
but mention should be made of the writings of Felix Pascalis Ouviere,
generally known under the name of Pascalis. Dr. Pascalis was a native of
Provence, France, and was born about 1750. Having graduated in medicine
at Montpellier, he went to St. Domingo, and there practised his profession
until driven out by the Revolution of 1793, when he came to Philadelphia,
and subsequently settled in New York, where he died in 1833. Besides his
works on Yellow Fever, he wrote a treatise on Syphilis, New York, 1812,
and contributed papers to journals. He was one of the editors of the Medi-
cal Repository.

Another writer on Yellow Fever who seems to be little known except in
the South is Dr. J. L. E. W. Shecut, a native of South Carolina, born in
Beaufort, 1770; died in Charleston, 1836. He studied under Dr. Ramsay,
of Charleston, graduated M.D. at Philadelphia in 1791, and at once com-
menced practice in Charleston.8 His most important essays were collected
and published in one volume, Charleston, 1819, under the title of "Shecut's

8 For these data I am indebted to Dr. Robert Lebby, Charleston.

JOHN SHAW BILLINGS

Medical and Philosophical Essays." This book, which is quite rare, contains
his account of the yellow fever of 1817, first published in that year, and also
his "Essays on Contagions and Infections," first published in 1818, and
should be consulted by those who wish to trace the history of opinions in
the South relating to this disease.

The principal work on Yellow Fever, which includes the information
of all others of a prior date, is that of Dr. Rene la Roche, published in 1855.
Dr. La Roche was of French descent, born in Philadelphia, in 1795, his
father being an emigrant from St. Domingo. Unlike the majority of promi-
nent American physicians, he was not connected with a large medical
school, and his justly deserved reputation rests entirely upon his writings,
and especially on his treatise on Yellow Fever, which is a model of re-
search, and is remarkable, not only for the number, but the accuracy of
its references, and the impartiality with which opposing statements are
given.

The most valuable recent articles on this disease are in the New Orleans
and the Charleston Medical Journals, but the great majority of them are
historical and controversial.

During the course of an epidemic, physicians are too busy to make ob-
servations which require much time or care, or to make more than brief
notes. The papers of Drs. Faget,9 Logan,10 and Sternberg,11 giving tempera-
ture observations, make an advance in the right direction, but we lack
data as to the pathological chemistry of the disease, and as to its relations
with the malarial fevers. With regard to this last class of diseases, our lit-
erature is even more extensive than that of the preceding, and occupies
much space in the journals of the West and South.

Our most valuable contribution to the natural history of malarial dis-
ease is the treatise of Dr. Daniel Drake, on the principal diseases of the
Interior Valley of North America. This work is the "Magnum Opus," and
results of the life-long labour, including extensive personal observations,
literary research, and matured reflection, of a man whose fame, as com-
pared with that of his contemporaries, will probably be greater a century
hence than it is to-day, and whose name, even now, should be among the
first on the list of the illustrious dead of the medical profession of the
United States. The son of an illiterate Kentucky pioneer, brought up in
a log cabin, attending a country school in the winter, and using the re-
mainder of the year working on a farm, he surmounted the obstacles thus
placed in his way, and by unceasing labour, joined to a sound common

9 New Orleans Med. and Surg. Journal, 1873, i., N. S., p. 145.

10 New Orleans Med. and Surg. Journal, 1874, ii. p. 779.

11 Araer. Jour. Medical Sciences, 1875, lxx. p. 99.

CENTURY OF AMERICAN MEDICINE

sense, which rose to the level of genius, took a leading position as author,
editor, practitioner, and teacher. Commencing the study of medicine at
the age of sixteen, he attended his first course of lectures in 1805, and his
second in the University of Pennsylvania, in 1815, at the end of which he
graduated. He was Professor successively in the Transylvania School, the
Medical College of Ohio; a second time in the Transylvania; the Jefferson
School; the Medical Department of Cincinnati College; the University at
Louisville; and again in the Medical College of Ohio. He died November
6, 1852. His first publication was a pamphlet on the climate and diseases
of Cincinnati, published in 1810, and reissued as "The Natural and Sta-
tistical View or Picture of Cincinnati and the Miami Country," published
in 1815. This work is quite rare, and is interesting as being the germ from
which sprung his great work above referred to.

He founded the "Western Journal of the Medical and Physical Sciences,"
which would be of much value, if for no other reason, on account of a
series of essays on Medical Education, by Dr. Drake, which were published
in it. These essays were issued in a separate volume, in 1832, and form,
upon the whole, the most satisfactory contribution to this vexed question
which this country has ever produced. He commenced the preparation of
his work on the diseases of the Mississippi Valley in 1822, and the second
volume was not issued until after his death. Very few of the younger physi-
cians of this country are familiar with his writings. Of his essays on Medical
Education and Diseases of North America, no second editions have been
published; but if there are any books to which the hackneyed phrase of
the reviewer, "No physician's library is complete without it," apply, it is
to these works of Dr. Drake, as far as American physicians are concerned,
and they are most distinctively and peculiarly American books, in subject,
mode of treatment, and style of composition.

The dissertation of Dr. J. K. Mitchell "On the Cryptogamous Origin of
Malarious and Epidemic Fevers," is an ingenious piece of reasoning, and
presents a summary of all the a priori arguments in favor of this theory
which can be advanced. The papers of Dr. Salisbury on the same subject
are without value.

Upon the subject of diseases of the chest the most noteworthy mono-
graphs have been the works of Morton, McDowell, Lawson, and Flint on
Consumption; of Horace Green on the Diseases of the Air-Passages; La
Roche on Pneumonia, and of Gerhard and Flint on Diagnosis of Diseases
of the Chest. The treatise on Phthisis, by Dr. L. M. Lawson, adds another
to the numerous examples of careful studies by physicians of diseases with
which they are themselves afflicted. Dr. Lawson was a native of Kentucky;
born 1812, died 1864. His early education was defective. At the age of
twenty he was licensed to practise, but it was not until 1838 that he ob-

JOHN SHAW BILLINGS

tained his diploma from the Transylvania School. In 1844 he was elected
to a Professorship at Lexington; from 1847 to 1853 he filled the chair of
Materia Medica in the Medical College of Ohio, and then became Pro-
fessor of Principles and Practice of Medicine. During the winter of 1859-
60, he lectured on Clinical Medicine in the University of New Orleans.
He founded, and for a long time conducted, the "Western Lancet," in
which many of his lectures were published.

Dr. W. W. Gerhard, 1809-72, was a native of Philadelphia, and a grad-
uate of the University of Pennsylvania. After taking his degree he spent
two years in Paris, and became thoroughly indoctrinated with the teach-
ings of Louis. On his return to Philadelphia he was appointed lecturer at
the Medical Institute, and Assistant Clinical Lecturer to Professor Jackson.
For twenty-five years he was the senior Physician to the Pennsylvania Hos-
pital. Some of his clinical lectures appeared in the "Medical Examiner,"
of which he was one of the editors. His principle work was his "Treatise
on Diagnosis of Diseases of the Chest," Philadelphia, 1842; second edition,
1846.

Dr. Horace Green, 1802-1866, was a native of Vermont, and a graduate
of Castleton Medical College in 1824. From 1840 to 1843 he was Professor
of Theory and Practice in the same school; and in 1850 took the same chair
in the New York Medical College, of which he was one of the founders,
continuing to lecture until 1860. In connection with this school he estab-
lished, with his colleagues, the "American Medical Monthly." He was the
first in this country to devote himself to a specialty, and his works on the
local treatment of diseases of the air-passages attracted much attention,
although they are not of a character to add permanently to his fame.

In medical jurisprudence, the systematic works of Beck, and Wharton
and Stille, and the treatise of Dr. Wormley on Poisons, are the most im-
portant, and each of them compares most favourably with any similar works
in existence.

There are probably not to be found in the annals of medicine so large
and valuable contributions to its literature by three brothers, as were made
by the Beck family of New York.

John B. Beck, 1794-1851, graduated in Columbian College in 1813, be-
came a pupil of Dr. Hosack, and graduated in Medicine at the College
of Physicians and Surgeons in 1817, presenting, as a thesis, a paper on In-
fanticide, which was published, and is still a standard work on this subject.
In 1822 he assisted in establishing the "New York Medical and Physical
Journal," with which he was connected for the next seven years, and in
which he published numerous articles. In 1826 he became Professor of
Materia Medica in the College of Physicians and Surgeons, just newly
organized. His principal works, in addition to those already alluded to

CENTURY OF AMERICAN MEDICINE

were his "Essays on Infant Therapeutics," New York, 1849; second edition,
1855; and his Historical Sketch of the State of Medicine in the American
Colonies; "Lectures on Materia Medica," and a collection entitled, "Re-
searches in Medicine and Medical Jurisprudence."

Theodoric Romeyn Beck, 1791-1855, graduated at Union College,
Schenectady, studied under Dr. Hosack, and graduated as M.D. at the
College of Physicians and Surgeons, in 1811. He was appointed Professor
of the Institutes of Medicine and Medical Jurisprudence in the College
at Fairfield, in 1815. In 1817 he became Principal in the Albany Academy,
and gave up the practice of medicine. In 1840 he took the chair of Materia
Medica in the Albany Medical College, which he held until 1854. His
great work was his treatise on Medical Jurisprudence, which appeared in
1823, in two volumes, and of which, including four English editions, ten
editions were issued during the author's life.

Dr. Lewis C. Beck, 1798-1853, the younger brother of the preceding,
studied medicine under Dr. Dunlop, and was admitted to practice in 1818.
In 1826 he was elected Professor of Botany and Chemistry in the Vermont
Academy of Medicine. This position he resigned in 1832. In 1836 he was
appointed Mineralogist to the Geological Survey of the State of New
York, and in 1840 was elected Professor of Chemistry and Pharmacy in
Albany Medical College. His contributions to medical literature, to chem-
istry, meteorology, and mineralogy, were numerous. His principal medical
work was his Report on Cholera, made to the Governor of New York in
1832.

The literature of obstetrics has been so fully given by Dr. Thomas, in
a preceding article of this series, that further reference to it is superfluous.
We will add only, with regard to Dr. Hugh L. Hodge, that he was a gradu-
ate of Princeton, a pupil of Dr. Wistar, and that his early taste was for
surgery rather than obstetrics. He was induced to change his specialty by
Dr. Dewees. He was afflicted with defective vision, which increased with
age, and his great work on Obstetrics was produced entirely by dictation.
He commenced as a lecturer in the Medical Institute, and was elected
Professor of Obstetrics in the University of Pennsylvania in 1835, the rival
candidate being Dr. Charles D. Meigs, a lecturer in the Philadelphia Asso-
ciation for Medical Instruction, who six years later obtained the chair of
Obstetrics in the Jefferson School. The literary works of Dr. Meigs com-
pare very unfavourably with those of his rival as to scientific value and
exactness, but they are much more attractive to students and those who
read for pleasure rather than instruction.

We have three names of American medical writers whose works should
be mentioned here, viz., Coxe, Watson, and Dunglison.

Dr. John Redman Coxe, 1773-1864, was a type of the medical scholar,

JOHN SHAW BILLINGS

who loves books for their own sake, and who takes more pleasure in dis-
covering a forgotten sentence in a folio of the fifteenth century than in
original investigations in the light of the present day. Born in Trenton,
New Jersey, he completed his classical education at Edinburgh, studied
medicine under Dr. Rush, and took his degree of M.D. at the University
of Pennsylvania in 1794, after which he continued his medical studies in
London, Edinburgh, and Paris for about two years. He was elected Pro-
fessor of Chemistry in the University of Pennsylvania in 1809, and of
Materia Medica and Pharmacy in 1818. He filled the latter chair until 1835,
at which date he retired, and was but little known thereafter. His Dispensa-
tory12 and Medical Dictionary13 were useful compilations, and met an
existing want. His Observations on Vaccination14 was his best original con-
tribution to medicine. His Inquiry on the Discovery of the Circulation of
the Blood was a paradoxical attempt to disprove the claims of Harvey.
His last work, and the one most in accordance with his tastes, was "The
Writings of Hippocrates and Galen," Philadelphia, 1846. He founded the
first medical journal published at Philadelphia, preceding that published
by Dr. Benj. Smith Barton by two months, and his library was, in its day,
the best collection of ancient authors on medicine in this country.

Dr. John Watson, of New York, has been alluded to in the article on
surgery. His literary tastes led him to historical studies and the collection
of a valuable library, and his historical sketch of ancient medicine15 shows
that he consulted and enjoyed consulting the original works of the fathers
in medicine.

Dr. Robley Dunglison, a native of Keswick, England, born in 1798, was
one of the most prolific of medical authors. He obtained his medical educa-
tion at Edinburgh, Paris, and London; settled in the latter city, where he
wrote a treatise on the diseases of children [1824], and was one of the
editors of the London Medical Repository in 1823-24. In 1824 he accepted
the invitation of Thomas Jefferson to fill the chair of Anatomy, Physi-
ology, Materia Medica, and Pharmacy, in the University of Virginia. At
this place he published in 1827 a syllabus of his course on Medical Juris-
prudence and prepared his Medical Dictionary. In 1833 he took the chairs
of Materia Medica, Therapeutics, Hygiene, and Medical Jurisprudence
in the University of Maryland, and from 1836 to 1868 was Professor of the
Institutes of Medicine in the Jefferson School. He died April 1, 1869. His
Systems of Physiology (first edition 1832), Hygiene (first edition 1835),
Therapeutics (1836), Practice (1842), and Materia Medica (1843), were

12 The American Dispensatory. Phila., 1806, 4th ed. 1818.

13 The Philadelphia Medical Dictionary. Phila., 1808, 2d ed. 1817.

14 Practical Observations on Vaccination. Phila., 1802.

15 The Medical Profession in Ancient Times. 8vo., N. Y., 1856.

CENTURY OF AMERICAN MEDICINE

popular in their day, nearly all of them passing through several editions.
The work by which he will be remembered is his Medical Dictionary. The
first edition of this was published at Boston in 1833, in two volumes. A
peculiarity of this edition is that it contains brief biographical sketches of
physicians, omitted in subsequent issues. The last edition, Philadelphia,
1874, edited by his son, is the most convenient work of the kind in existence.

Our literature on insanity and the pathology of mental disease is insig-
nificant in comparison with the importance of the subject and the oppor-
tunities existing for its study, the only monograph of permanent value
being the "Contributions to Mental Pathology," by Dr. Isaac Ray, 8vo.,
Boston, 1873. Considering the number and size of the asylums for the insane
in this country, and the amount of money which has been spent upon
them, it is rather curious that the medical officers connected with them
should have contributed so little to the diagnosis, pathology, or thera-
peutics of diseases of the nervous system. An examination of the works
relating to this subject, and more especially of the American Journal of
Insanity, which is the most important, and which contains the transactions
of the Association of American Superintendents of Hospitals for the In-
sane, will show that the thoughts of these specialists have been mainly di-
rected to the subjects of construction and management of asylums and to
the jurisprudence of insanity. This last subject is one of great and increasing
importance; but our contributions to its literature consist rather of opin-
ions and ontological speculations than of scientific observations. The an-
nual reports of our insane asylums consist, for the most part, of business
and financial statistics, and are intended for the use of appropriation
committees rather than of physicians. There are some signs, however, that
more attention will hereafter be given to recording of the physical phe-
nomena of mental disease, and it is to be hoped that we may soon have
some published results from the pathological department of the Utica
Asylum, which will stimulate other institutions to undertake similar work.
No more promising field to-day exists in medical science for valuable dis-
coveries than in the wards and laboratory of a large, well-appointed hos-
pital for the insane.

Upon the subject of hygiene no systematic work has yet been produced
in this country, with exception of the treatise on Military Hygiene, by Dr.
Hammond. One of the principal writers in this department was Dr. John
Bell, a native of Ireland, 1796-1875. He came to this country with his
parents, who settled in Virginia in 1810, and graduated in medicine in
the University of Pennsylvania, after which he lectured for some years in
the Philadelphia Medical Institute, and for two years in the Medical Col-
lege of Ohio. His treatise on Baths and Mineral Waters is the only com-
prehensive and respectable treatise on this subject published in this coun-

JOHN SHAW BILLINGS

try. The most important contributions to the literature of hygiene which
we have produced are the reports of the various State and municipal boards
of health, most of which, however, are of comparatively recent origin, and
it is to be hoped are only just fairly commencing their career of usefulness.

The subject of hospital construction and hospital hygiene has been much
discussed in this country, the latest production being a large and hand-
somely illustrated work published by the trustees of the Johns Hopkins
Hospital of Baltimore.

The publications of our municipal, State, and national governments,
relating to vital and medical statistics, are among our most valuable con-
tributions to medical literature. The reports of city and State boards of
health show each year evidences of more careful investigation into the
probable causes of disease and the means of removing or diminishing them,
and the necessity and economic value of such work is slowly but steadily
becoming apparent to the educated classes of the community by means of
the publications referred to.

The circulars and reports of the Medical Department of the Army are
sufficiently well known, and within the last few years a series of reports
have been commenced by the Medical Department of the Navy and by the
Marine Hospital Service of the Treasury Department, which it is to be
hoped will become important additions to our medical literature, not only
in regard to statistics, but in the departments of hygiene, pathology, and
therapeutics. It should not be forgotten by the physicians of the United
States that they are, to a certain extent, responsible for the condition of the
medical departments of the government, since the sympathy and opinions,
expressed or implied, of the medical profession at large as to the work
which these departments have done, or are trying to do, furnish the en-
couragement and stimulus which are necessary to the continuous produc-
tion of good results, and also influence to a considerable extent the action
of our legislators with regard to the officers of these departments.

The reports of the Surgeon-Generals of the Army, the Navy, and the
Marine Hospital Service, while ostensibly presented to the Secretaries of
War, the Navy, and the Treasury, are really, in a sense, made to the physi-
cians of the country, who are the only competent judges as to whether the
work is satisfactory, and commensurate with the means which have been
allowed for its performance.

Of encyclopedic works, the result of the combined labour of many au-
thors, like the great French dictionaries, but one specimen has been at-
tempted in this country. This was the American Cyclopaedia of Practical
Medicine and Surgery, edited by Dr. Isaac Hays, of which two volumes,
completing the letter "A" were published at Philadelphia in 1834-36, and
reissued with a new title, "Medical and Surgical Essays," in 1841. The time

CENTURY OF AMERICAN MEDICINE

is perhaps not far distant when a first-class publication of this character
will be sufficiently in request in this country to warrant an attempt at its
production.

Reprints and Translations. — The second class of medical works referred
to in our statistics, includes the reprints and translations, which cannot be
overlooked in an account for our medical literature, since they have formed
an important part of the libraries of American physicians, even if quantity
only be considered.

Prior to the Declaration of Independence, the largest and most impor-
tant medical book printed in this country was the "Lectures on Materia
Medica," of Cullen, issued at Philadelphia in 1775, in 4to., and advertised
as "The very cream of physic," and as "absolutely necessary for all Ameri-
can physicians who wish to arrive at the top of their profession." 16

In 1776 was published, at Philadelphia, the treatise of Van Swieten on
the Diseases Incident to Armies, with Ranby on Gunshot Wounds, and
Northcote on Naval Surgery, forming a small volume of 164 pages, which
is usually found bound with the second edition of John Jones' "Practical
Remarks," etc., of the same date, and was probably the principal guide of
the army surgeons during the Revolutionary War. Cullen's "First Lines
of the Practice of Physic" was reprinted from a smuggled copy, in 1781,
at Philadelphia, in two volumes, 8vo., and five later American editions,
the last edited, with a great flourish of trumpets, by Dr. Caldwell, in 1822,
attest its popularity.

For thirty years after the Declaration of Independence, the majority of
the reprints were works of English and Scotch writers, and especially of
the Edinburgh school, the favourite authors being Cullen, Brown, John
Hunter, Benjamin Bell, Denman, Smellie, Hamilton, Beddoes, and Robert
Jackson. The largest edition sold was probably of the "Edinburgh New
Dispensatory." The only translations of French or German medical works
issued in this country prior to 1800 were, Swediaur on Venereal, New York,
1788, and Blumenbach's "Elements of Physiology," Philadelphia, 1795.
The first medical book printed in Louisiana was "Medicaments et precis
de la Methode de M. Masdevall," a pamphlet of 48 pages, relating to the
yellow fever, issued in 1796.

The beginning of the influence of the French schools, which for the next
fifty years was so powerful in the United States, especially in surgery, is
marked by the editions of Boyer and Desault, Philadelphia, 1805, to which
rapidly succeeded the works of Alibert, Richerand, and Bichat. In this
connection may be permitted a reference to two works which are omitted

16 A copy of this work was purchased by the Library of the Pennsylvania Hospital
1780, for £135 5s. currency, equal to £1 15s. specie.

JOHN SHAW BILLINGS

from our statistics, since they were intended for non-professional use,
but which had an extensive sale, and indirectly exerted a very considerable
influence, viz., Buchan's Domestic Medicine, of which several editions
were issued, the most important being that of Philadelphia, 1795, revised
by Dr. S. P. Griffitts, and the "Primitive Physic," of John Wesley, of which
there are several American editions of the last century.

Many foreign medical works have been issued in this country in con-
nection with periodicals, such as the "Register and Library of Medical and
Chirurgical Science," published at Washington, D. C, 1833-36, in which
were issued "Bell on the Nerves," "Lawrence on the Eye," Velpeau's Sur-
gery, etc.; The Select Medical Library, edited by John Bell; the American
Medical Library, published under the supervision of Dr. Dunglison; and
the "Medical News and Library," in which some valuable books have been
issued.

The number of translations of French medical works which have been
published in this country is one hundred and forty-eight (148). One hun-
dred and one of these were issued prior to 1842, and only eight have ap-
peared within the last ten (10) years.

The number of translations of German works issued has been sixty-four
(64), of which but fourteen (14) were issued prior to 1842, and twenty-eight
(28) within the last ten years.

The number of reprints of English medical books has been five hundred
and eighty-four (584), thirty (30) of these were issued prior to 1800; two
hundred and seventeen (217) during the next forty years, and three hun-
dred and thirty-seven (337) since 1840, the production gradually increasing.

It is largely to French and German sources that we owe our works on
pathology, pathological anatomy, pathological chemistry, and physiology.

The best systematic treatise on the practice of medicine from the Ger-
man, published in this country, was that of Niemeyer, in 1869, the name
of the author having been made somewhat familiar to the American public
by a translation of his lectures on Phthisis, published the year previous.
The works of Billroth on General Surgical Pathology, New York, 1871,
Rindfleisch, a Text-book of Pathological Histology, Philadelphia, 1872,
are the books which are to-day directing the work of the younger profes-
sional men of the country. The Cyclopaedia of the Practice of Medicine,
edited by Ziemssen, now in course of publication, is the most extensive
medical work, native or foreign, which has ever been issued in the United
States, and is probably destined to exercise great influence upon our in-
vestigation of diseases, whatever it may do for the practice.

Of the translations from the French, the most important have been those
relating to anatomy, physiology, and surgery. The favourite authors have
been Bichat, D. J. Larrey, Boyer, Orfila, Magendie, Laennec, Cazenave

CENTURY OF AMERICAN MEDICINE

Baudelocque, Louis, Velpeau, Broussais, Cazeaux, Colombat, Ricord, Vi-
dal, and Malgaigne.

It would be useless to give lists of the titles of these; it is sufficient to
say that they include nearly every important monograph or text-book pro-
duced by English writers: from Cullen, Brown, and Darwin, to Bennett,
Watson, and Aitken; from John Hunter, Benjamin, John and Charles
Bell, Pott, Hey, and the Coopers, to Erichsen, Paget, and Holmes; and from
Hamilton and Smellie to Simpson, Barnes, and Duncan. The works of
nearly all the great English teachers have been quickly reproduced on this
side of the water, and their modes of treatment are those followed by the
majority of our practitioners.

A few medical books have been printed in Spanish at Philadelphia, for
the Mexican trade, including the "Compendio de la Medecina," by J. M.
Venegas, 1827. The number of reprints in this country has been largely due
to the want of an international copyright law, for which reason publishers
found it much cheaper to take the work of an English author gratis, than
to pay an American writer for his MS. Sometimes the name of an American
physician is given as editor of the reprint, but in most cases, this means
little more than he approves the book, the so-called editing being imper-
ceptible. To this remark a few honourable exceptions should be made, such
as the additions by John Bell to the lectures of Stokes, of Gerhard to Graves;
the reprints of Copland's Dictionary, in which the bibliographical addi-
tions, made by Dr. Charles A. Lee, are numerous and valuable, the editions
of Velpeau's Surgery by Mott and Blackman, and the editions of Aitken's
Practice by Dr. Clymer, who has added much to the completeness of the
work.

This so-called editing was the subject of some caustic criticism, and
has of late years almost entirely disappeared. With regard to the merits of
the International Copyright question, there has been much discussion.
On the one side, it is truly said that the desire for books increases by the
supply, and that the sale of the cheap reprints produces a market for in-
digenous productions. On the other side, it is affirmed with equal truth,
that it deprives our own writers, to a great extent, of pecuniary induce-
ments to labor. The question is one to be decided, however, by the laws
of morality rather than expediency, and the majority of educated non-in-
terested parties agree that the passage of an international copyright law
would be an act in accordance with the dictates of common honesty and
justice.

Undoubtedly, the cheapness and abundance of these republications have
done much to diffuse knowledge among our practitioners, and the li-
braries of many physicians have been mainly composed of the "pepper and
salt sheepskin covered Philadelphia reprints." Of late years there has been

JOHN SHAW BILLINGS

a marked improvement in the quality of paper and typography of our
medical books, while the stout bindings of sheep and calf of fifty years ago,
have been largely superseded by the more showy, but, at the same time,
more flimsy cloth bindings now in vogue. The German fashion of pub-
lication in parts has been almost unknown, except as connected with pe-
riodicals, and it is to be hoped that it may be long before the annoyance
and confusion which attends the Lieferung and Hefte may be connected
with our medical publications. "The American Clinical Lectures," edited
by E. C. Seguin, and published by G. P. Putnam 8c Sons, look in this direc-
tion most unpromisingly, and the publication of such totally unconnected
papers, in a series of continuous paging, even if special paging is added,
must be unhesitatingly condemned by all who have occasion to either make
or to verify bibliographical references to them.

It may be of interest to refer to some statistics of the locality of publica-
tion of these works. Of class one we find that three hundred and seventy-
three (373) first editions were published in Philadelphia, one hundred and
seventy-three (173) in New York, eighty-one (81) in Boston, twenty-four (24)
in Cincinnati, sixteen (16) in New Orleans, and fifteen (15) in Baltimore,
leaving ninety-six (96) published elsewhere. If each edition be reckoned as
a separate work, we find that six hundred and thirteen (613) have appeared
in Philadelphia, two hundred and twenty-six (226) in New York, ninety-
six (96) in Boston, and eighteen (18) in Baltimore. Of the reprints and
translations, six hundred and eighteen (618) books, or seven hundred and
fifty-three (753) editions have been issued from Philadelphia, one hundred
and seventy-seven (177) books, or two hundred and nineteen (219) editions
from New York, eighty (80) from Boston, and ninety-four (94) elsewhere.
It appears then that more than one-half of our medical books have been
published in Philadelphia, and about one-fifth in New York. The firm of
Carey, Lea & Carey, now H. C. Lea, has published nearly six hundred
editions of medical works; and those of Lindsay 8c Blakiston, and Lippin-
cott, each between one and two hundred. In New York, the principal pub-
lishing house is that of S. S. 8c W. Wood, now Wm. Wood 8c Co., which has
issued about one hundred and fifty (150) editions.17

Medical Journals. — It is not in text-books or systematic treatises on
special subjects that the greater part of the original contributions to the
literature of medicine have been first made public during the last cen-
tury, either in this or other countries. Since the year 1800 medical journal-
ism has become the principal means of recording and communicating the
observations and ideas of those engaged in the practice of medicine, and

17 The figures of this distribution among publishers are only an approximation, and
are probably too small, since the publishers' names are not stated in many of the lists
of books from which titles have been derived.

CENTURY OF AMERICAN MEDICINE

has exercised a strong influence for the advancement of medical science
and education.

To this class of literature this country has contributed a noteworthy
share. Excluding those devoted to dentistry, pharmacy, popular hygiene,
and "isms" of various kinds, we find that one hundred and ninety-five
medical journals have been commenced in this country, including reprints
of foreign journals, making in all one thousand six hundred and thirty-
seven volumes, or a greater bulk than the text-books and monographs.

Prior to the establishment of medical periodicals, there was little or no
encouragement or opportunity for a physician to record his observations.
The professor in a medical school might, in an introductory notice to the
thesis of one of the students — the so-called programma or propempticon
inaugurate — make a statement, not to exceed sixteen pages upon any sub-
ject, whether connected with that treated of in the thesis or not, and some-
times such a paper was continued through the programmata of twenty
or thirty different dissertations, making it very difficult at the present day
to secure the entire work.

But if the country doctor had a communication to make to his brethren,
he must either do it by a pamphlet printed at his own expense, or must
forward it to some one connected with a medical school or scientific asso-
ciation, and trust to him that it should be made known and recorded. The
professors themselves, as was natural, gave the greater part of their thought
and labour to their systems, theories, and commentaries.

It was the day of large books, and unless one could produce a volume,
he received little encouragement to write. At the present day, the demand
for brief papers and reports of single cases, exceeds the supply.

The weekly and monthly periodicals are omnivorous and insatiable in
their requests for contributions. Through the medical journals have been
given to the world nearly all the discoveries which the science and art of
medicine owes to American physicians. They furnish the original data
which are the foundations of monographs and text-books, and their files
remain interesting and vauable when the latter have become obsolete and
are forgotten.

Medical journalism in the United States presents some peculiarities,
although not nearly so many as is commonly supposed, and has been the
subject of severe, and, to some extent, merited criticism; but while it in-
cludes some of the worst, it also contains the best of our medical literature,
and some details as to its rise, progress, and character, may therefore be of
interest.

The first medical journal printed in this country was a selection and
translation from the "Journal de Medicine Militaire," issued in Paris from
1782 to 1788. This translation was published in New York about 1790,

JOHN SHAW BILLINGS

forming a volume of one hundred and twenty pages 8vo., which is quite
rare.18 The original journal from which this is made up is one that is
valuable to the army surgeon; and the reprint is here referred to as being
the first medical journal printed in the United States; and because the
fact of its existence is probably known to very few.

The first American medical journal was a quarterly, "The Medical Re-
pository," edited by S. L. Mitchell, Edward Miller, and E. H. Smith, and
published at New York, from 1797 to 1824. That this met an existing
want is shown by the fact that the demand for the earlier volumes was
sufficient to warrant the issue of a second edition of the first and second
volumes in 1800, and a third edition of the same volumes in 1804-5.

Dr. Elihu H. Smith, the projector of this journal, was born in Connec-
ticut in 1771, graduated at Yale in 1786, and died in 1798. Although so
young, he had edited several works, and contributed largely to literary
periodicals, as well as to his own medical journal.

Dr. Samuel L. Mitchell, 1764-1831, studied under Dr. Bard, and grad-
uated in medicine at Edinburgh, in 1786. As Professor of Chemistry and
Natural History in Columbia College, and from 1820 to 1826 of Materia
Medica and Botany, chief editor of the "Medical Repository," representa-
tive in Congress in 1801-4, and 1810-13, and United States Senator, 1804-9,
he lectured and wrote upon almost all subjects, and his papers are scattered
through various periodicals at home and abroad. He was rather a naturalist
than a physician, and has very properly been called a "Chaos of Knowl-
edge."

Dr. Edward Miller, 1760-1812, was a native of Delaware, and a gradu-
ate of the Medical Department of the University of Pennsylvania in 1789.
In 1807 he accepted the chair of the Practice of Physic in the College of
Physicians and Surgeons, and in 1809 was appointed one of the Physicians
to the New York Hospital. His writings were collected and published in one
volume in 1814, the most important being his papers on Yellow Fever.

The idea of the publication of the "Medical Repository" was probably
taken from the "Annals of Medicine" of Duncan, a continuation of the
"Medical and Philosophical Commentaries of Edinburgh," and of which
the "Edinburgh Medical Journal" of the present day is the successor. Al-
though, owing to the tastes of Dr. Mitchell, it contains many dissertations
which are now obsolete, the entire set of twenty-three volumes is even to-
day well worthy of a place in the physician's library. At its close its sub-

18 "A Journal of the Practice of Medicine, and Surgery and Pharmacy in the Military
Hospitals of France. Published by order of the King. Reviewed and digested by M.
De Home, under the inspection of the Royal Society. Annotated from the French by
Joseph Brown. No. I., vol. i., New York: J. McLean & Co."

CENTURY OF AMERICAN MEDICINE

scribers passed to the "New York Medical and Physical Journal," and from
that time, New York city has never been without a medical periodical.

Thirty-one medical journals have been commenced in that city, besides
nine devoted to specialties, and six reprints of foreign journals. The most
important of these, in addition to those already named, are the "American
Medical and Philosophical Register," edited by Drs. Hosack and Francis,
1810-14; the "New York Medical Magazine," edited by Mott and Onder-
donk, the "New York Journal of Medicine and Surgery," 1839-41, one of
the best journals in this country, edited by Drs. Watson and Swett, the
"New York Journal of Medicine," edited by Forry, Lee, Stephen Smith,
and others, continued as the "American Medical Times," of which the
"Medical Record" of to-day may be considered as the representative; the
"New York Medical Journal," edited successively by Drs. Hammond,
Dunster, and Hunter, 1865-76, and the "Archives of Scientific and Prac-
tical Medicine," edited by Brown-S^quard, 1873, which unfortunately
ceased with its fifth number. The "Buffalo Medical Journal," edited by
Dr. Austin Flint, 1845-60, and then merged in the "American Medical
Monthly," is also a valuable series.

The second medical journal published in this country was the "Phila-
delphia Medical Museum," edited by Dr. Coxe, 1804-1811, followed al-
most immediately by the "Philadelphia Medical and Physical Journal,"
edited by B. S. Barton, and published at irregular intervals, 1804-1809.
This journal, as was to be expected from the tastes of its editor, contains
a large proportion of articles on natural history. Other well-known jour-
nals published in Philadelphia are the "American Medical Recorder,"
a quarterly, 1818-29, whose subscription list passed to the "American
Journal of the Medical Sciences;" the "North American Medical and
Surgical Journal," 1826-31; the "Medical Examiner," 1838-56, which
united with the "Louisville Review," forming the "North American
Medico-Chirurgical Review," 1857-61; the "Medical and Surgical Re-
porter," 1856-76; the "Photographic Review of Medicine and Surgery,"
1870-72; and the "Philadelphia Medical Times," 1870-76.

The most important journal on our list is the "American Journal of the
Medical Sciences." This began as the "Philadelphia Journal of the Medical
and Physical Sciences," in 1820, under the editorship of Dr. N. Chapman,
who is said to have undertaken it under the stimulus of the phrase of Sidney
Smith, so often quoted during the past year: "Who reads an American
book?" In 1825 a new series began, edited by N. Chapman, W. P. Dewees,
and J. D. Godman. This continued until 1827, when Dr. Isaac Hays, who
had been associate editor in the last volume — number five of the new, or
fourteen of the whole series — took charge of the Journal and gave it its
present name. The ninety-seven volumes of this Journal need no eulogy.

JOHN SHAW BILLINGS

They contain many original papers of the highest value; nearly all the real
criticisms and reviews which we possess; and such carefully prepared sum-
maries of the progress of medical science, and abstracts and notices of
foreign works, that from this file alone, were all other productions of the
press for the last fifty years destroyed, it would be possible to reproduce
the great majority of the real contributions of the world to medical science
during that period. It is evident that its editor has exercised a careful su-
pervision over every part, but his personality is nowhere apparent, there
being no editorial articles, and very few papers appearing over his signa-
ture.

Baltimore produced the third of our medical journals, the "Baltimore
Medical and Physical Recorder," edited by Dr. Tobias Watkins, 1808-9.
This only reached number one (1) of the second volume, and it is some-
what curious that of the ten medical journals and one reprint which have
been commenced in that city, the duration of each has been comparatively
brief. One little known may be referred to, "The Baltimore Philosophical
Journal and Review," edited by Dr. J. B. Davidge, of which one number
was published in 1823. It contains "a memoir on fractures of the thigh-
bone," and "a case of extirpation of the parotid," each by the editor.

The first medical periodical published in Boston was of a popular char-
acter, "The Medical and Agricultural Register," 1806-7. The "New Eng-
land Journal of Medicine and Surgery" began as a quarterly in 1812, and
in 1828 was consolidated with the "Boston Medical Intelligencer," and
became a weekly, forming "The Boston Medical and Surgical Journal,"
which has continued to the present time. The original quarterly was well
edited, and contains some valuable papers. Under the editorship of Dr.
J. V. C. Smith, which lasted for over fifty volumes, it would seem that no
articles were ever refused admission to the weekly. As stated by Dr. Hunt,19
"John C. Warren and X. Chabert were received with equal courtesy. In its
department of reviews it was most complacent. From Rokitansky to Mrs.
Joel Shew all were erudite. On its editorial pages nothing was attacked,
everything was conciliated. Legitimate medicine was right to be sure, but
the community would apreciate it better if it were not quite so right. Con-
tributors of merit dropped off, and the journal became the receptacle of
more 'remarkable cases' than any other was ever blessed with." From the
date of this criticism there has been great improvement, and it is to-day
one of the best.

The first medical journal west of the Alleghanies was the "Western
Quarterly Reporter of Medical, Surgical, and Natural Science," edited by
John D. Godman, Cincinnati, 1822-23, which reached number two of the

Buffalo Medical Journal, 1856, xii. p. 312.

CENTURY OF AMERICAN MEDICINE

second volume. This was followed by the "Ohio Medical Repository,"
edited by Guy W. Wright, issued semi-monthly, Cincinnati 1826-27. This
has become one of the rarest of American medical journals. The only ar-
ticles of interest which it contains are a series of papers by Dr. John Locke,
on the Medical Botany of the West, and a few reports of cases and contribu-
tions to pathological anatomy, by Dr. John P. Harrison. (This journal
must not be confounded with another of the same name, published at the
same place, in 1835-36.) It was merged into the "Western Medical and
Physical Journal," edited by Drs. Daniel Drake and Wright. At the end of
the first volume, in 1828, the editors agreed to disagree, and Dr. Wright
published one number of a second volume, but the real continuation was
issued by Dr. Drake, under the title of the "Western Journal of the Medical
and Physical Sciences." This contained some of Dr. Drake's best and most
characteristic writings, and forms a valuable and interesting series.

Two attempts were made by Dr. Eberle to establish a journal at Cincin-
nati; the first, the "Western Medical Gazette," after one or two suspensions,
ceased with the second volume, in 1835; the second, the "Western Quar-
terly Journal of Practical Medicine," 1837, did not get beyond the first
number. "The Western Lancet," edited by L. M. Lawson, continued from
1842 to 1857, when it took the name of "The Cincinnati Lancet and Ob-
server," which is still flourishing. Several medical journals were started
at Columbus, only one of which, "The Ohio Medical and Surgical Jour-
nal," 1848-64, was successful. A rare medical periodical and curiosity in its
way is "The Belmont Medical Journal," published at Bridgeport, Ohio,
under the auspices of the Belmont County Medical Society, 1858-60. With
this belong the transactions of the same society from 1847 to 1857, forming
in all, three small volumes in 12mo. These publications are unique in their
way, and illustrate what can be done by a county medical society, com-
posed entirely of country practitioners. They contain some amusing flights
of rhetoric, and some well-recorded cases, and many of the papers are in-
teresting because it is evident that they were written precisely as the
authors talked.

The first medical journal of Kentucky was the "Transylvania Journal
of Medicine," a quarterly, published at Lexington, from 1828 to 1839,
forming a series of twelve volumes, of which complete sets are rare and
valuable. In 1840 commenced "The Western Journal of Medicine and Sur-
gery," Louisville, 1840-55, which may be considered as a continuation of
Dr. Drake's "Western Journal," above referred to, combined with the
"Louisville Journal of Medicine and Surgery," edited by Drs. Yandell,
Miller, and Bell, in 1838, and of which but two numbers were published.

"The Richmond and Louisville Medical Journal," now in course of
publication, edited by Dr. E. S. Gaillard, 1868-76, is a continuation of the

JOHN SHAW BILLINGS

"Richmond Medical Journal," published at Richmond, Va., 1866-68. "The
American Practitioner," edited by Drs. D. W. Yandell and T. Parvin,
1870-76, is a continuation of the "Cincinnati Journal of Medicine," com-
menced in Cincinnati in 1867.

"The Illinois Medical and Surgical Journal" commenced at Chicago in
1844, and has continued to the present time under various names, being
now known as "The Chicago Medical Journal and Examiner."

The first journal published west of the Mississippi was "The St. Louis
Medical and Surgical Journal," founded by Dr. M. L. Linton, in 1843,
which is still in existence.

In the South the first medical periodical was the "Journal de la Societe
Medicale de la Nouvelle Orleans," a quarterly, published in 1831. A
monthly journal of the same name appeared in 1859-61. The most im-
portant is the "New Orleans Medical and Surgical Journal," which, with
two suspensions, has continued from 1844 to the present time. "The South-
ern Medical and Surgical Journal," edited by Anthony Eve and others,
published at Augusta, forms a series of twenty-one volumes, which contain
many valuable cases, papers, and reports. "The Charleston Medical Jour-
nal and Review," 1846-60, and 1873-76, is the principal medical periodical
of South Carolina.

In Tennessee, "The Nashville Journal of Medicine and Surgery," 1851—
61, and 1866-76, and "The Southern Journal of the Medical and Physical
Sciences," 1853-57, are worthy of note.

The principal medical journal in Virginia was "The Virginia Medical
and Surgical Journal," edited by G. A. Otis and others, Richmond, 1853-
61. In the same city was published, during the war, "The Confederate
States Medical and Surgical Journal," 1864-65, a quarto sheet containing
much valuable data in military surgery. Complete files of this are very
rare.

On the Pacific coast eight medical journals, in all, have been commenced,
two of which did not get beyond the first number. The oldest one now in
existence is "The Pacific Medical and Surgical Journal," which began in
1858.

Five medical journals have been commenced in Michigan, two of which
are now in existence.

Connecticut, Iowa, Maine, Minnesota, New Hampshire, New Jersey,
Oregon, Vermont, and West Virginia have each had one journal, all of
which are now extinct except "The West Virginia Medical Student." Per-
haps two may be claimed from Maine, counting "The Journal of the
Medical Society of Maine," one number of which was issued at Hallowell
in 1834.

Of journals devoted to dentistry there have been about twenty, making
one hundred and thirty volumes in all.

CENTURY OF AMERICAN MEDICINE

The earliest one was the "American Journal of Dental Science," which
commenced in New York, in 1839, was suspended from 1860 to 1867, and
is still in existence.

In 1876 there are four dental journals in existence in this country,
while England has but one, France two, and Germany one.

Of journals devoted to pharmacy, there have been six worth mention-
ing; the oldest being the present "American Journal of Pharmacy," which
began in 1825, as the "Journal of the Philadelphia College of Pharmacy."
This journal is by far the most valuable of this class in this country, and
is furthermore noteworthy, and to be specially commended for having done
what no medical journal in this country has accomplished, namely, the
publishing of a complete index for its series, which was done in 1873, and
which doubles the practical value of the set. The total number of volumes
published of this class is ninety-four.

Besides the regular encyclopedic medical journals, there have been
about as many more devoted to "isms" and "pathies," and to popular and
family medicine and hygiene, many of these last being merely advertise-
ments.

With the recent development of specialties in medicine, several journals
devoted to particular subjects have appeared, and an increase in the num-
ber of these may be expected.

In this connection may be mentioned, as a curiosity in literature, a
periodical publication devoted to the abuse of an individual physician,
namely, the "Rush Light," published in New York in 1800, by William
Cobbett, under the pseudonym of Peter Porcupine, for the vilification of
Dr. Benjamin Rush. Seven numbers were issued, of which only the first
two bore the imprint of place of publication, the last two were printed in
London, and a complete set is very rare.

A most powerful agent for the diffusion in this country of the knowledge
of the labours and writings of European physicians, has been the republi-
cation of the principal English Quarterly Reviews, of "Braithwaite's Retro-
spect," and of "Ranking's Abstract." To this should be added, perhaps,
the so-called "American Edition of the London Lancet," which is a selec-
tion rather than a reprint, and the subscription list of which was at one
time very large.

Of journals printed in foreign languages, there have been commenced,
three in German, three French, and one Spanish. The French journals
were all issued at New Orleans; two of the German journals appeared in
the State of New York, and one in Philadelphia.

The Spanish journal was intended mainly for circulation in Cuba.20 Its
issue ceased with the third number.

=° "Revista Mcdico-Quirurgica y Dentistica." Quarterly. New York and Havana, 1868.

JOHN SHAW BILLINGS

Our medical journals vary so much in character, style, and purpose, that
it is hardly possible to make any assertion with regard to the mass which
shall be at the same time broad and true. They may be divided into three
classes: first, those not connected with any medical school, and which draw
their contributions from a wide field, including such as the "American
Journal," "The New York Journal," "The Medical Record," "The Medi-
cal Times," and "The Boston Medical and Surgical Journal;" second,
those which rely for contributions and material mainly on the professors
of a medical school and the hospital clinics connected with it, but which
are not specially devoted to its interests; third, those which are mainly de-
voted to advocating the interests of a school, and the attacking rival insti-
utions, and which are, to use Carlyle's phrase, "Windmills put out to catch
or take advantage of the wind of popular favour." These journals some-
times contain valuable reports of cases obtained from the college clinics,
but the personal editorial element in them is usually in excess, and they
are of interest to but a small local circle. To them applies the untranslat-
able French criticism, "II y a trop de tintamarre la dedans, trop de brouil-
lamini."

Of the first class, some compare favourably with the best of the journals
of other countries: of the last class, some are as bad as, but not worse than,
the worst. Comparatively few persons are acquainted with the poorer class
of foreign medical journals, published in the smaller towns of the prov-
inces, which have most of the defects which are so strongly condemned in
some of our own publications as if they were unique.

The reports to the American Medical Association, by its committees on
American Medical Literature, devote much space to periodicals, and con-
tain many judicious criticisms upon their defects and errors. A common
complaint is that there are too many. The reply to this is usually that of
Dr. Drake, that it is desirable that the country practitioners be induced to
write, and that one means of doing this is the diffused localization of jour-
nals. This is due to the fact that inexperienced and modest men will fur-
nish an article or report to a journal in their immediate neighbourhood,
with whose editor they are personally acquainted, while they would not do
so to one at a distance.

The number of subscribers to the greater number of our journals is
small, the issue being, for many, less than a thousand, and, for some, hardly
five hundred copies.

The motive for the existence of the minor journals is not for direct profit,
but as an indirect advertisement for certain individuals, or — and this is
more common — the desire to have a place in which the editor can speak
his mind and attack his adversaries without restraint. The defects in the
medical journals are, to a certain extent, the characteristic ones in our

CENTURY OF AMERICAN MEDICINE

medical literature, and are chargeable mainly to the lack of general educa-
tion and mental culture in the majority of readers whose tastes are to be
accommodated. An urgent want of many of the subscribers is a sort of con-
tinuation of the course of education given in the schools. We find, for in-
stance, in the pages of some medical journals, articles which make no pre-
tensions to originality, but are simply didactic lectures to a class in absentia.
The defects in the so-called original contributions are, for the most part,
due to imperfect education in the writers, and betray, not merely an ig-
norance of facts previously ascertained and recorded, but defective mental
training and an inability to comprehend the relations of the facts which
are known, the result of which is the stringing out of a series of irrelevant
and tedious details, and, in the attempts at deduction, the production ei-
ther of vague and valueless generalizations, or conclusions which do not
follow from the premises. As an illustration, take the majority of the ar-
tilces which have appeared on a disease which would seem to be peculiar
to this country, viz., the so called "milk-sickness" or "trembles."

Since the first notice on this affection in Dr. Drake's Notices of Cincin-
nati, in 1809, there have been printed four pamphlets and one hundred and
ten (110) articles in journals and transactions, on this subject. Yet it cannot
be said to-day, that we have any definite knowledge as to the pathology
or causes of this affection, or that, so far as man is concerned, we are ab-
solutely certain that there is any special disease which should be thus
named, as being caused by the milk, or flesh of cattle affected with the
"trembles." It has been said to be caused by certain plants, yet no scientific
experiments have been made on the effects of these plants. No attempt has
been made to produce the disease in an animal remote from infested lo-
calities, by the use of the suspected plants, or better, by the use of an ex-
tract containing their active principles; no chemical or microscopical ex-
aminations have been made, in short, we have nothing but an account of
symptoms, and much of that is from hearsay.

Many articles intended to be practical, are very far from being such,
although the authors would probably be surprised and indignant to hear
them termed otherwise. They profess to give the results of the writer's
personal experience with a certain disease, but this disease is only named,
not described, and the gross results only are given, that is to say, we are
told how many recovered. The object of such writers, to use their own
words, is to tell us "what is good for biliousness, or low fever, or pneu-
monia." Their productions read curiously, like the literature of the last
century, and are to be classed with old women's advice; amusing generally;
practically suggestive sometimes; clear, scientific, and conclusive, never.

The so-called clinical lectures, and reports of cases and operations, are
of two kinds. When properly prepared they are most useful and valuable,

JOHN SHAW BILLINGS

and are the best contributions to a journal which the majority of physicians
can make, although by no means the highest class of medical literature. But
a large number of such articles as are published, are simply padding, worse
than useless, since their titles become a part of the bibliography of medi-
cine, compelling each succeeding inquirer to refer to them, or risk the loss
of some really valuable reference.

We have reached that stage of development, when it is in no way de-
sirable that we should be informed that one dislocated shoulder was re-
duced, one leg amputated, and two hare-lips operated upon, not even if the
usual text-book explanations are added, so as to make up the five or six
pages of the report of a college clinic. We have had enough reports of
specimens of "Aneurism of the Aorta," or "Medullary Sarcoma," or "Tu-
mour of the Breast," in which little or no information is given with regard
to the symptoms during life, and the principal fact stated is the size or
weight of the specimen.

It is a useless case of labour which lingers through three or four pages,
to terminate in the usual manner with the stale old moral about "meddle-
some midwifery," and it is at once amusing, exasperating and pathetic, to
glance over the "contributions from the clinic" of the young specialist who
has set to work to write himself into notice, not in a journal devoted to his
specialty, but in one of the encyclopedic periodicals, having been in-
structed that this is "legitimate advertising."

"Medical journalism is not a profession in this country. With one or two
exceptions, our medical editors are engaged in practice and lecturing, and
their labour in connection with the journals is not directly remunerative,
nor is it the main object of their thoughts." The result of this appears in
that large section of almost every journal which is devoted to reviews, ab-
stracts, news items, etc. Nevertheless, as we have before stated, our medical
journals are the most important and valuable part of our medical litera-
ture, and it is mainly in and by them that improvement may be hoped for
and effected.

At the beginning of 1876, there were in course of publication through-
out the world about 280 regular medical journals. Of this number, Ger-
many and Austria had 57; France 52; Great Britain, not including her
Colonies 29; the United States 46; Italy 31; Belgium 8; Mexico 8; Canada
7; Holland 6; Spain 6. As to the form of publication, the United States has
the largest proportion of monthlies, and France and Germany of weeklies
and bi-weeklies.

The proportion of periodical to other forms of medical literature is in
excess in this country, as will be clearly seen if we compare the number
of medical books published in the several countries. Taking the "Biblio-
theca Medico-Chirurgica," of Ruprecht, for the years 1874-75, and count-

CENTURY OF AMERICAN MEDICINE

ing the publications noted in it, excluding journals, pamphlets, and popu-
lar and irregular works, we find that the United States is credited with 55
volumes; England 179; France 409; Germany 419; Italy 120; Spain and
Portugal 104. If we count only first editions of original works, we find that
the United States has published during these two years 36; England 92;
France 314; Germany 288; Italy 88; and Spain and Portugal 30.

These figures are, of course, not exact, but the proportions shown are
probably nearly correct. Taking the number of volumes of medical pub-
lications of all nations, excluding journals, for these two years, the United
States has published about six per cent, of the whole, certainly not the
quantity which should have been produced if everything was as it should
be.

Medical Societies. — An important influence upon the progress of medi-
cine, and the relations of physicians to each other, and to the public, has
been exerted by our medical societies, some of which date from the last
century, and which are found almost everywhere. The first State medical
societies, such as those of New Jersey, Massachusetts, Delaware, New York,
etc., were charged with the duty of licensing persons to practise medicine,
to which license an examination was a necessary preliminary. In this way
these societies were the principal agents in fixing the standard of medical
education, and although after the establishment of medical schools the
diploma of one in good repute was accepted in lieu of an examination, this
was by courtesy rather than law, and made it necessary that the standard
of the schools should at least be equal to that prescribed by the society. For
convenience of reference, we give a list of the most important medical so-
cieties of the United States, arranged in alphabetical order by States: —

No. of
First Vols.
Organized Publica- of

tion Publica-
tions

American Medical Association 1847 1848 27

American Ophthalmological Society 1864 1865 7

American Otological Society 1868 1869 1

American Pharmaceutical Association 1852 1852 24

American Public Health Association 1872 1875 1

National Quarantine and Sanitary Convention 1857 1857 4

Medical Association of the State of Alabama 1847 1848 19

State Medical Association of Arkansas 1870 1871 5

Medical Society of the State of California 1870 1870 5

Territorial Medical Society of Colorado 1871 1872 5

Connecticut State Medical Society 1792 1844 20

Medical Society of Delaware 1789

Medical Society of the District of Columbia 1833 1874 2

Clinico-Pathological Society of Washington 1865 — —

Florida Medical Association 1874 1875

JOHN SHAW BILLINGS

Organized

Georgia Medical Association 1849

Georgia Medical Society of Savannah 1804

Illinois State Medical Society 1851

Drake Academy of Medicine 1872

Indiana State Medical Society 1849

Iowa State Medical Society 1850

Medical Society of the State of Kansas 1858

McDowell Medical Society 1874

Kentucky State Medical Society 1851

Societe Medicale de la Nouvelle Orleans 1812

Medical Society of the State of Maine 1834

Maine Medical Association 1853

Medical and Chirurgical Faculty of Maryland 1789

Boston Society for Medical Improvement 1828

Boston Society for Medical Observation 1846

Boylston Medical Society 1811

Gynaecological Society of Boston 1869

Massachusetts Medical Society 1781

Michigan State Medical Society 1819

Minnesota State Medical Society 1855

Medical Association of the State of Mississippi 1856

Medical Society of the State of Missouri 1850

Nebraska State Medical Society 1868

New Hampshire Medical Society 1791

New Jersey State Medical Society 1766

Medical Association of Southern Central New York 1847

Medical Society of the County of Albany 1806

Medical Society of the County of Kings 1822

Medical Society of the County of New York 1806

Medical Society of the State of New York 1807

Medico-Legal Society of New York 1867

New York Academy of Medicine 1847

New York Medical Journal Association 1864

Pathological Society of New York 1844

Physico-Medical Society of New York 1815

Medical Society of the State of North Carolina 1850

Academy of Medicine of Cincinnati 1857

General Medical Society of Ohio 1827

Medical Convention of Ohio 1835

Ohio State Medical Society 1846

Belmont Medical Society 1847

Medical Society of the State of Oregon 1874

College of Physicians of Philadelphia 1787

Medical Society of the State of Pennsylvania 1848

Pathological Society of Philadelphia 1857

First
Publi-
cation

1850

1851
1874
1849
1850
1867
1875
1851
1831
1834
1853
1853
1853

No. of
Vols,
of

Publica-
tions

23
1

27
10
2
1

19
3
1

6
4

[70 prize essays
published in
[journals.

1869

1790

1850

1870

1850

1869

1854

1859

1848

1864

1858

1808
1874
1851

1817
1850

1829
1835
1850
1848

1793
1851
1869

5
41
15
6
1

12
6
21
17
11
2
2

34
1

2
13

11
18
4

CENTURY OF AMERICAN MEDICINE

No. of
First Vols.
Organized Publi- of

cation Publica-
tions

Philadelphia County Medical Society 1849 — —

Philadelphia Obstetrical Society 1868 1873 3

Rhode Island Medical Society 1812 1859 1

Medical Society of South Carolina 1789 — —

South Carolina Medical Association 1848 1849 16

Tennessee State Medical Society 1830 — —

Medical Association State of Texas 1869 1869 4

Medical Society of the State of Vermont 1814 1864 4

Medical Society of Virginia 1821 1871 5

Medical Society of Washington Territory 1873 1873 3

Medical Society of the State of West Virginia 1867 1868 8

Wisconsin State Medical Society 1842 1856 9

The formation of the American Medical Association was due to a wide
spread and loudly expressed dissatisfaction on the part of the leading
physicians of the country, with the low standard of medical education,
and to a general conviction that the remedy for this lay neither with the
schools nor the State medical societies. It was hoped that by forming an
association which should represent all parties interested, a sufficient pres-
sure of opinion might be brought to bear upon physicians and upon the
schools, to secure the return to the requirements for graduation of the
earlier medical colleges. After one or two futile attempts, the New York
State Medical Society set on foot a movement which resulted in a meeting
of a convention in the city of New York, in the year 1847, in which were
present representatives of medical societies and colleges from sixteen States.
A similar convention met the following year in Philadelphia, at which the
title, by which it is now known, was assumed. The series of its annual vol-
umes of transactions contains some reports and papers of much value and
interest, mingled with much that is unworthy of publication under the
auspices of our National Medical Society, or indeed of any other. Many of
the reports of the chairmen of the several committees are of permanent his-
torical value. Its most valuable contribution to our literature, has been
the publication of a code of ethics, which is, theoretically at least, accepted
as authoritative throughout the United States, and which, although some
of its provisions have been objected to, is, as a whole, the most satisfactory
exposition in existence of the proper relations of physicians to each other,
and to the public.

Of late years, the original purpose of this association has been to some
extent departed from.

It was not primarily intended to promote literature or scientific research,
or to afford a means of publication for writers. Our national and State

JOHN SHAW BILLINGS

medical societies have been mainly useful as social gatherings, promoting
acquaintance, and the feeling of professional brotherhood and esprit de
corps among their numbers, and as giving the means for agreement, and
the expression of opinion, upon questions relating to education, ethics,
etc.; by that large body of physicians engaged in general practice, who
do not write or lecture, but simply vote. As sources of addition to the
science and literature of medicine, they do not play a conspicuous part,
nor is it easy to see how it can be otherwise; the real discovery, the care-
fully prepared paper, the description of a new symptom, pathological ap-
pearance or remedy are not usually communicated to such societies. No
effectual supervision as to quality of papers which may be read or printed
can, or at least will be exercised by committees, and a communication
which a first class medical journal has "declined with thanks," may be
taken to the State, and even to the National Society with a reasonable
certainty that it can be made to appear in the transactions. The discussions
on papers in such associations seldom have any scientific value, from want
of special preparation on the part of the speakers, although they are some-
times amusing, and, to use an expressive word, "spicy," from the use of
personalities. Whether this state of things can be improved is doubtful,
though attempts to do so are of course commendable.21

The journals have to a great extent superseded the necessity of using
societies as a means of publication, and the best work of such associations
seems to consist in bringing the leaders into personal relation with the
mass of the profession, and in serving as courts of arbitration and appeal,
where local difficulties can be adjusted, and whose decisions will command
the assent of the majority of their members.

The Transactions of the New York State Medical Society were, for a
number of years, published by the State, which proved, upon the whole,
to be not a desirable mode of issue, and the last volume, published by the
society itself, is a great improvement upon its predecessors. What such
societies might do is shown by the paper of Dr. Thomas C. Brinsmade,
giving an accurate record of his practice for twenty-one years. This makes
300 pages of the volume of the Transactions of the New York State Medi-

21 The best suggestion to this end for the American Medical Association which I have
heard is that each section should elect its own officers and members, and should be
managed by a special committee who shall designate the subject for discussion, and the
leaders in debate. If the members of the committee each year are selected from a single
city, it would have an additional advantage. For instance, let the managing committee
of the surgical section be, this year, all residents in New York city, while Boston takes
obstetrics, Philadelphia practice, etc. The next year New York can take practice, Chicago
surgery, etc. In other words, transfer all the responsibility for scientific work to the sec-
tions, and let these sections be organized and managed systematically to that end alone.

CENTURY OF AMERICAN MEDICINE

cal Society for 1858, and contains carefully analyzed statistics of 37,872
cases. This had been preceded in 1851 by an elaborate account of the medi-
cal topography of the city of Troy, his place of residence. Taken together,
these papers are very valuable, and set an example of a mode of adding to
the store of medical knowledge, which is within the power of every prac-
titioner.

An interesting experiment is now in course of trial in Alabama, where
the State Medical Society has been made the State Board of Health, and
the official adviser of the Legislature in all matters pertaining to public
hygiene.

The American Public Health Association, organized in 1872, may now
be considered as fairly established. The operations of this society have
special interest to the medical profession, since it may become an important
means of educating the public, and enabling it to distinguish between the
scientific physician and the ignorant pretender.

We have another class of medical societies which require an abundance
of clinical and pathological material; members actually engaged in origi-
nal investigations, and frequent meetings, as conditions for usefulness and
success. As a rule, these can only exist in large cities, where they exert
a powerful influence and stimulus to exertion on their individual mem-
bers. It must be admitted that our societies of this kind seldom bring out
the best work of their members, and that such discussions as occur in simi-
lar societies in London and Paris, continued week after week, and even
month after month, for which elaborate preparation is made by the speak-
ers, and in which the results of clinical observation and extensive literary
research are rendered attractive and striking, by splendor of diction and
perfection of style, are very rare.

The most important of these societies are the College of Physicians of
Philadelphia, the New York Academy of Medicine, the pathological so-
cieties of Philadelphia and New York, the Boston Society for Medical
Improvement, and certain societies devolted mainly to specialties. Among
these should be mentioned the Medico-Legal Society of New York, organ-
ized in 1867. In 1874 it published a volume of papers relating to medical
jurisprudence, which will be followed by others. It is also forming a valu-
able library in its own department, and has been the means of bringing
the members of the medical and legal professions of New York to better
acquaintance with each other. It is but justice to say that much of its good
work and prosperity is due to the energy of its late president, a prominent
lawyer, Mr. Clark Bell.

The majority of our physicians are, and must be, content to leave to a
few special workers the labour and pleasure of sifting and selecting from
the original sources of medical literature, having neither the wish nor the

JOHN SHAW BILLINGS

power to examine for themselves the works of the great leaders and
teachers of times past, or the mass of books and pamphlets which are daily
streaming from the press; but there is nevertheless among them a fair
amount of appreciation of the value and necessity of such work, and of the
usefulness and desirability of collections of the records of their science.
During the last ten years, the writer has had occasion to examine many
private libraries of physicians in all parts of the country, in country villages
as well as the large cities, and it has been a matter of surprise and pleasure
to find so much interest taken in subjects relating to the history and bib-
liography of medicine by men remote from large libraries, and without the
stimulus of companionship in, and sympathy with such tastes. And it will
usually be found that the physician who has on his shelves half a dozen
old folios and quartos, including perhaps copies of Sydenham, Morgagni,
and Van Swieten, is a man of more culture and broader views than the one
who has only the modern manuals, or rather those which were modern
when he attended lectures.

Until recently few of our writers have made much use of bibliographical
research. We now have public medical libraries in this country, which af-
ford to the student and scholar good facilities for research, and which bid
fair, at no distant day, to rival in magnitude and practical working value,
if not in manuscripts and incunabulae, the best in the old world.

Philadelphia has several libraries of much interest and value to the
medical bibliographer and scholar. The oldest medical library in this
country is that of the Pennsylvania Hospital, founded in 1762, and now
containing about 13,000 volumes, many of which were selected for the
hospital by Doctors Lettsom, in London, and Louis, in Paris. Its classed
catalogue, issued in 1857, is a valuable work of reference.

The Library of the College of Physicians, of Philadelphia, which dates
from 1788, now contains about 19,000 volumes well selected, receives about
eighty current journals, and, next to the library at Washington, is the most
valuable collection of the kind in this country. Much of its prosperity and
excellence is due to Doctor Samuel Lewis, whose donations, amounting
to several thousand volumes of choice books, are kept in a room by them-
selves, and known as the "Lewis Library." The great want of this library
is a good printed catalogue, which would double its value and usefulness.
The medical part of the Loganian Section in the Philadelphia Library
contains about 1800 volumes, mostly old and rare. These three libraries
supplement each other to a great extent, there being probably not less than
26,000 volumes between them, which are not duplicates. The fourth library
is at the University of Pennsylvania, in West Philadelphia, and contains
about 3000 volumes, the gift of Dr. Alfred Stille\ It may be noted here that
almost all attempts to establish medical libraries in connection with medi-

CENTURY OF AMERICAN MEDICINE

cal schools have been failures. Commenced with enthusiasm, they soon be-
come antiquated, are rarely consulted, except by one or two species of
beetles, are never properly catalogued or cared for, and dust and mould
reign in them supreme. Students and teachers want the newest books and
journals only. Libraries are used by the scholar and author, and for such
are the true universities.

In New York, the library of the New York Hospital is the largest of
its class, containing about 10,000 volumes. An excellent foundation for a
library has been acquired by the Academy of Medicine, by the gift from
Dr. Purple of a complete file of regular American medical journals and of
a large number of rare pamphlets. The collections of journals of the Medi-
cal Journal Association of New York, and the German Dispensary are val-
uable sources of information to the student.

The Boston Public Library has at present the best collection of medi-
cal books in that city, numbering about 11,000 volumes, for the most
part standard works and periodicals. Its usefulness is much diminished
from the want of a good printed catalogue of this section. The library
of Harvard College contains between 5000 and 6000 volumes on medi-
cine; and the Treadwell Library, at the Massachusetts General Hospital,
has about 5000 volumes. The medical library of most promise in Boston
is that of the Medical Library Association, which, though only a year old,
has about 3000 volumes, and will probably rapidly increase.

In Cincinnati the City Hospital has a fair collection. The Mussey Medi-
cal and Scientific Library, at present, is a special deposit in the Cincinnati
Public Library, and contains about 4000 volumes and 2000 pamphlets.

The National Medical Library at Washington, under the direction of
the Surgeon-General of the Army, contains 40,000 volumes, and about the
same number of pamphlets. It has been formed within the last twelve years,
and the use that is made of it by physicians from all parts of the country,
and the general and strong interest that is felt in its progress affords satis-
factory evidence, if such were needed, that it meets a want of the profession.
Its subject catalogue is nearly ready for the press.

Besides these public libraries, there are several valuable private collec-
tions of medical works in this country, some of which have been already
given to public use, such as those of Drs. Purple, Stille, and Mussey, al-
ready referred to. Two others are worthy of special mention, the first being
that of Dr. G. J. Fisher, of Sing Sing, which is rich in the classics of medi-
cine; and the second, that of Dr. J. M. Toner, of Washington, which is
especially devoted to American medical literature, and contains many rare
pamphlets, besides a nearly complete file of American medical journals.
In connection with this last, there is nearly ready for the press a complete
index. Besides these, there are a number of valuable private medical li-

JOHN SHAW BILLINGS

braries in this country, ranging from 1000 to 8000 volumes, and the num-
ber of foreign works imported, and the taste for original editions is steadily
increasing. It is now possible to verify in this country the majority of the
references made by European medical authors, and it is no longer necessary
to make costly importations, or to visit Europe to obtain literary data.

With the libraries should be classed the medical museums, of which
several of much interest and importance have been formed in the United
States, for the most part in connection with medical societies and hospitals.
The catalogues of these collections, when properly prepared, are very use-
ful books of reference, and some excellent work of this kind has been ac-
complished, such as the Catalogues of the Warren Anatomical Museum of
Harvard, and of the Museum of the Boston Society for Medical Improve-
ment, each by Dr. J. B. S. Jackson; of the Pathological Museum of the
Pennsylvania Hospital, by Dr. Wm. Pepper; of the Pathological Cabinet
of the New York Hospital, by Dr. Ray; and of the Army Medical Museum
at Washington, by Drs. Woodhull, Curtis, and Woodward.

The College of Physicians of Philadelphia has a valuable collection,
including the Mutter Museum, and a series of unique preparations by
Hyrtl.

The practical value of large special museums in connection with good
libraries devoted to the same specialties is great, but they are useful
rather to the educated physician than to the student; and the numerous
small collections which are scattered over the country, in hospitals and
private cabinets, are simply so much wasted and unused material, in a
scientific point of view, and, though gratifying to the owner as trophies
or mementoes, are of little more real use than the strings of teeth which
the barbers of old hung out as signs of their skill.

The value of a single specimen of any lesion is usually very small; it
is only when they can be brought together by scores and compared that
useful and reliable results can be hoped for. As we get older and wiser,
we shall probably have fewer journals, medical schools, museums, and
libraries than we now possess, for all these means of culture, to have the
best effect, require concentration.

Although the permanent importance of oral teaching has, to some ex-
tent, been diminished by the diffusion of periodical literature, since the
latest discovery or theory can now be promptly made known to those re-
mote from the great centres of learning, the increased use made of clinical
instruction, and the necessity for practical demonstration of instrumental
methods of diagnosis, have in a great degree compensated for this.

The medical history of a country cannot be considered complete with-
out some account of its medical schools, but we have space for little more
than a list of those which have flourished in the United States.

CENTURY OF AMERICAN MEDICINE

The following table gives a list of the regular chartered medical schools
of this country, which have had the power of conferring the degree of
doctor of medicine, with the date of first graduating class, date of cessa-
tion, and number of graduates to the spring of 1876, so far as it has been
possible to obtain the data: —

It is possible that a few minor schools of short duration have been over-
looked, but such must have been of small importance. No note is made in
the list of the various changes of name which some of the schools have as-
sumed. The number of graduates has been obtained by collation of all the
catalogues that could be obtained, and by correspondence. From these data
an estimate has been made for the missing years, and the limit of error in
the total does not probably exceed one-half of one per cent. It should be
observed that little reliance can be placed upon many of the catalogues as
to the number of students in attendance, and there are some discrepancies
even as to graduates.

Year of Date of Total
Name First Cessa- No. of

Graduation tion Graduates

Alabama

Medical College of Alabama [Mobile]

California

Medical College of the Pacific, Med. Dept. of University

(City) College [San Francisco]

University of California, Med. Dept. of (Toland Hall)

[San Francisco]

Connecticut

Yale College, Med. Dept. of [New Haven]

District of Columbia
National Medical College, Med. Dept. of Columbian

University [Washington]

Georgetown University, Med. Dept. of [Washington] ....

Howard University, Med. Dept. of [Washington]

Georgia

Medical College of Georgia [Augusta]

Savannah Medical College [Savannah]

Atlanta Medical College [Atlanta]

Oglethorpe Medical College [Savannah]

Illinois

Rush Medical College, Med. Dept. of University of Chi-
cago [Chicago]

Illinois College, Med. Dept. of [Jacksonville]

Rock Island Medical School [Rock Island]

Chicago Medical College, Med. Dept. of Northwestern

University [Chicago]

Indiana

Indiana Medical College, Med. Depart, of Laporte Uni-
versity [Laporte]

Medical College of Evansville [Evansville]

1860 203

1859 — 90
1865 86
1814 899

1826 427

1852 — 387

1871 — 37

1833 — 1278

1854 — 140

1855 560

1856 1861 86

1844 — 1786

1848 1848 39

1849 1849 19

1860 — 481

1842 1851 136

1850 — 74

JOHN SHAW BILLINGS

Year of Date of Total

Name

First

Cessa-

No. of

Graduation

Gr3.du3.tcs

T ,. „ ..... . „ ,, r. ,.

1850

1852

1870

251

Indiana College of Physicians and Surgeons [Indian-

1875

CIo liege of Physicians and Surgeons [ICeokuk ]

1850

—

777

1871

111

K.€Ti tiic ky

Transylvania X-Jniversity, N^ed. Dept. of [Lexington] ....

1818

1859

1860

T_Jniversity of Louisville lVled Dept of [Louisville]

1838

—

2395

1851

—

520

T onicwillf* \/f r* c\ 1 r* a 1 f!ol 1 f*(Tf* IT .on icvillfl

1870

— ■

402

Hospital College of Medicine, lV^ed. Dept. of Central

University [Louisville]

1875

—

LouisiciTwi

University of Louisiana, Nted. Dept. of [New Orleans] ....

1835

—

1703

N^ew Orleans School of lVledicine [N"ew Orleans]

1857

1870

397

f^haritv T-Tocmi ta 1 A/fpHif*?»1 f^Iollpcrp of C~) INpw f^)r1pan^l

v.ulal i L V llUSUllal iVH. U1L a J V^UH^g k, \JL J. 1 . V-/ • i y— vv v_y 1 I v_ ci 11 3 J .

1876

—

Ad 0,1716

T^o\A;r1oin C^. o 1 \c*crr* q n H H SsfViool of 1 RTiinQ\A7ir*lf 1

JJUW UU111 CXlikA. 1V1^U> kJ^llvJUl Ul 1\ A 1 11 |_ U 1 Ullo W Iv^IV J . ■

1821

—

1137

Ad cLtyl dtid

University of Maryland lVIed Dept of [Baltimore]

1811

—

3104

\A7 QcV»iT^rrt'on T Trm/prciM/ Srnnnl of r\ innp IRnIti m nrp 1
V V aoXXXXXL! L<JXX Ulll v CI ally } O^XHJUX \JL IVXCUlvlllC (_J_J<11 L 1 1 A1W1 C J . .

1828

—

680

f^oll^rr^ of PVi vein ^n<! anrl Ssi i rfrpnrt Q IHaltimnrf1

1873

—

118

A/f n rr/7 rnit cpffc

T— X a r*\rc* i*o T In i\/prci t\7 \A r\ Tlf*ot" of 1 HnQf nn 1

1785

—

2206

*Rf»rlf Qhirp \/f edipal f~!ollf*crp TPitt'sfif'lrll

1823

1867

1136

Adlchl{?CLTl

University of iVtictiigan, IVIed. Dept. of [Ann Arbor]

1851

—

1405

1869

—

204

AdlSSOUTl

\/f i ccoi iri \A i 51 1 l;ol 1 f*crf* \S\t T .on 1 Q

1841

—

921

T onic \/T c\ \ r* n 1 f~^o1 1 t^crf1 \r\t T .01 1 1 ^

1843

—

1293

T-Ti i m ool H t \yf^o l r* a 1 llo 1 1 f* ctc- \r\t T .0111^ 1

1867

1869

10/u

—

St Louis College of Physicians and Surgeons [St Louis]

1870

Nczu HdTTtpshlTS

0 T-tm 01 1 tV» Pnl 1 f*cr(* TVTpH ira 1 Srhnnl of 1 H annufrl

1798

—

1283

Al^rt] Vnrk"
1 V etc J. yji /V

College of Physicians and Surgeons of the City of N^ew

York, Med. Dept. of Columbia College [N. Y. City].

1769

—

3179

College of Physicians and Surgeons of the Western Dis-

1816

1840

585

Geneva College (Rutgers Med. Faculty) [N. Y. City]

1827

1830

104

1835

1872

849

1839

1287

University of the City of New York, Medical Dept. of

[N. Y. City]

1842

3393

1847

848

CENTURY OF AMERICAN MEDICINE

Year of Date of Total

Name First Cessa- No. of

Graduation tion Graduates

New York Medical College and Charity Hospital [N. Y.

City] 1851 1864 310

Long Island College Hospital [Brooklyn] 1860 — 531

Bellevue Hospital Medical College [N. Y. City] 1862 — 1908

College of Medicine of Syracuse University [Syracuse] . . . 1873 — 26
Ohio

Medical College of Ohio [Cincinnati] 1821 — 2170

Cincinnati College, Med. Dept. of [Cincinnati] 1836 1839 95

Starling Medical College [Columbus] 1836 887

Cleveland Medical College, Med. Dept. of Western Re-
serve College at Hudson [Cleveland] 1844 — 1162

Cincinnati College of Med. and Surgery [Cincinnati]... . 1852 — 760

Miami Medical College [Cincinnati] 1853 — 578

University of Wooster, Med. Dept. of [Cleveland] 1865 — 328

Oregon

Willamette University, Med. Dept. of [Salem] 1867 — 63

Pennsylvania

University of Pennsylvania, Med. Dept. of [Philadel-
phia] 1768 — 8845

College of Philadelphia [Philadelphia] 1790 1791 10

Jefferson Medical College [Philadelphia] 1826 6668

Pennsylvania College at Gettysburg, Med. Dept. of

[Philadelphia] 1840 1861 769

Franklin Med. College of Philadelphia [Philadelphia] . . 1847 1849 25

Philadelphia College of Medicine [Philadelphia] 1847 1859 502

Rhode Island

Brown University, Medical School of [Providence] 1814 1826 68

South Carolina

Medical School of the State of South Carolina [Charles-
ton] 1825 - 2439

University of South Carolina, Med. Dept. of [Columbia] . . 1868 — 26

Tennessee

Memphis Medical College [Memphis] 1847 1873 231

University of Nashville, Med. Dept. of [Nashville] 1852 1741

Shelby Medical College [Nashville] 1859 1861 30

Vanderbilt University, Med. Dept. of [Nashville] 1875 — 75

Texas

Galveston Medical College [Galveston] 1866 — 123

Texas Medical College and Hospital [Galveston] 1874 — 38

Vermont

Castleton Medical College [Castleton] 1820 1861 1449

University of Vermont and State Agricultural College,

Med. Dept. of [Burlington] 1823 — 573

Vermont Medical College [Woodstock] 1830 1860 575

Virginia

University of Virginia, Med. Dept. of [Charlottesville] 1828 — 533

Medical College of Virginia [Richmond] 1839 — 947

Winchester Medical College [Winchester] 1846 1862 75

Total

73,588

JOHN SHAW BILLINGS

If we take the number of graduates by decades of years during the
present century, the result is as follows: —

Years Years Gr^T

1769-1799 221 1840-1849 11,828

1800-1809 343 1850-1859 17,213

1810-1819 1,375 1860-1869 16,717

1820-1829 4,338 1870-1876 14,704

1830-1839 6,849

The first medical school in this country was established by Drs. John
Morgan and William Shippen at Philadelphia in 1765, and is now known
as the Medical Department of the University of Pennsylvania. From its
halls have graduated the majority of the distinguished medical writers,
teachers, and practitioners of the United States, and the names of its pro-
fessors have become household words.

Organized upon the plan of the Edinburgh Medical School, of which
its founders were graduates, it has been the model and pattern by which
all our medical colleges have been shaped. Its largest graduating class was
in 1849, numbering 191. In the following year Professor Chapman re-
signed, and for the next ten years the Jefferson School graduated the
greater number, reaching its maximum of 269 in 1854. The Jefferson
Medical College was founded in 1824, under the charter of Jefferson
College in Canonsburg, Pennsylvania. The first course of lectures was de-
livered in 1825-26, the Faculty being Drs. Eberle, McClellan, Rhees, Green,
and Beattie. Numerous changes were made in professors, and its classes
varied much in size until 1841, when all the chairs were vacated and refilled
by Drs. Dunglison, J. K. Mitchell, Pancoast, R. M. Huston, Mutter, Meigs,
and Bache. This Faculty continued until 1856, when Professor S. D. Gross
succeeded Dr. Mutter. In 1857 Dr. T. B. Mitchell took the place of Dr.
Huston, and in 1858 Dr. Dickson that of Dr. J. K. Mitchell.

The second medical school founded in this country was at New York,
under the charter of King's College, in 1767. This school has had many
vicissitudes, but is now in a flourishing condition, and known as the Col-
lege of Physicians and Surgeons of the City of New York, being the Medi-
cal Department of Columbia College. Its largest graduating class was 110
in 1875.

The Medical Department of Harvard University was founded by Dr.
John Warren in 1782. Its maximum class of graduates was 99 in 1866.
Recently it has led the way in elevating the standard of medical education,
by extending its curriculum to three years, establishing a graded course,
and by having decided to institute a real examination into the prelimi-
nary education of its students. This has of course diminished its classes

CENTURY OF AMERICAN MEDICINE

somewhat, but no one can doubt that the decision to aim at quality instead
of quantity is a wise one, and will in the fulness of time receive its due
reward.

The first medical school in the West was established in Lexington, Ky.
So early as 1799 a Medical Department was added to Transylvania Uni-
versity, Dr. Samuel Brown being appointed the first professor. Various
appointments in the Medical Faculty were made, and a few partial courses
of lectures were delivered, but the first full course was not given until 1817,
and the degree of M.D. was first conferred in 1818. The founders of the
school were Drs. Dudley and Caldwell. Its period of greatest prosperity was
from 1830 to 1837, at which last date a disruption took place, and a part of
the Faculty removed to Louisville.

The Medical Department of the University of Louisville began as the
Medical Institute, chartered in 1833. Nothing was accomplished, however,
until the quarrel in the Transylvania School above referred to took place,
when Dr. Caldwell enlisted in the cause of the Louisville School, and in
1837 succeeded in obtaining for it a grant of a square of ground, and money
for buildings and apparatus. Lectures began the same year, the Faculty
consisting of Drs. Caldwell, Cooke, and Yandell, from the Lexington
School, and of Drs. Cobb, Henry Miller, and J. B. Flint. In 1839 Dr. Drake
joined the School, and in the following year Dr. S. D. Gross took the place
of Dr. Flint. In 1846, the School was transferred to the University, and in
1874 it had 123 graduates, its largest class.

In connection with these schools a special reference is due to Dr. Charles
Caldwell, their principal promoter. He was of Irish descent, born in North
Carolina in 1772; died 1853. After obtaining the best education which his
native State could afford, he went to Philadelphia in 1792, and continued
the study of medicine under Dr. Rush, passing his examination in 1794,
and taking his diploma in 1796. During the next twenty years his pen was
constantly busy with lectures, addresses, and controversial articles, many
of which related to yellow fever. In 1819 he accepted an invitation to the
Transylvania School, and from this time he gave his best energies to this
institution, and subsequently to the Louisville School. He was one of the
most voluminous writers which this country has produced, but he contrib-
uted little or nothing of permanent or scientific value to the literature of
his profession, and the only work of his which is worth perusal to-day is
his autobiography. His critical reviews, being dictated almost exclusively
by personal prejudices, are in almost all cases samples of special pleading
rather than true criticism, and characterized by their "smartness" rather
than their justice.

In the South the Medical College of South Carolina, chartered in 1823,
leads the way. The Medical College of Louisiana was incorporated in 1835,

JOHN SHAW BILLINGS

and in 1845 became the Medical Department of the University of Lou-
isiana. This school is remarkable as having received State aid to the amount
of $121,000.

In connection with the medical schools, notice should be taken of the
Medical Institute of Philadelphia, otherwise known as the Summer School,
which, in addition to furnishing instruction to students and supplementing
the winter course, was of very great value as a training school for Professors.
It was founded in 1817 by Dr. Chapman, and with it were connnected, from
time to time, Drs. Chapman, Horner, Dewees, Samuel Jackson, J. K.
Mitchell, John Bell, Hodge, Neill, Gibson, Gerhard, Norris, and Pepper.

The total number of graduates from our medical schools during the five
years ending July 1, 1875, was about 10,250, that is, a little over 2000 per
year; the number in 1875 being about 400 more than in 1871.

Dr. J. M. Toner estimated the average age of beginning practice to be
241/2 years, of death 58 years, making an average of about 34 years practice
to each.22

Dr. S. E. Chaill^ estimates that there are about 47,000 regular physicians
in the United States, being about one to every 700 of the population.23

Space is wanting for further details with regard to our medical schools.
That there are too many of them is a general complaint, the answer to
which is the same as that given above with regard to the like objection with
regard to medical journals, and which answer is of about the same value
in each case.

In attempting to estimate the quantity and value of the additions made
by the medical profession of this country to the world's stock of knowledge
of the laws of healthy and diseased action, and the means of modifying
these actions, it is very difficult to make generalizations which shall be at
once clear, comprehensive, and correct. This difficulty becomes an impos-
sibility, if we are to speak of the education, mental characteristics, and
professional qualifications of the whole body of physicians of this, or any
other country, since only the most vague and indefinite statements will
hold good. We have had, and still have, a very few men who love science
for its own sake, whose chief pleasure is in original investigations, and to
whom the practice of their profession is mainly, or only, of interest as fur-
nishing material for observation and comparison. Such men are to be
found for the most part only in large cities where libraries, hospitals, and
laboratories are available for their needs, although some of them have pre-
ferred the smaller towns and villages as fields of labour. The work of our

22 Statistical Sketch, etc. Indiana Journ. of Med., 1873, vol. iv. p. 1.

28 The Medical Colleges, etc. New Orleans Med. and Surg. Journ., 1874, vol. i. N. S.
p. 818.

CENTURY OF AMERICAN MEDICINE

physicians of this class has been for the most part fragmentary, and is found
in scattered papers and essays which have been pointed out in preceding
essays; but buds and flowers, rather than ripened fruit, are what we have
to offer. Of the highest grade of this class we have thus far produced no
specimens; the John Hunter, or Virchow, of the United States, has not yet
given any sign of existence.

We have in our cities, great and small, a much larger class of physicians
whose principal object is to obtain money, or rather the social position,
pleasures, and power, which money only can bestow. They are clear-headed,
shrewd, practical men, well educated, because "it pays," and for the same
reason they take good care to be supplied with the best instruments, and
the latest literature. Many of them take up specialties because the work is
easier, and the hours of labour are more under their control than in gen-
eral practice. They strive to become connected with hospitals and medical
schools, not for the love of mental exertion, or of science for its own sake,
but as a respectable means of advertising, and of obtaining consultations.
They write and lecture to keep their names before the public, and they
must do both well, or fall behind in the race. They have the greater part
of the valuable practice, and their writings, which constitute the greater
part of our medical literature, are respectable in quality, and eminently
useful.

They are the patrons of medical literature, the active working members
of municipal medical societies, the men who are usually accepted as the
representatives of the profession, not only here, but in all civilized coun-
tries; they may be famous physicians and great surgeons in the usual sense
of the words, and as such, and only as such, should they receive the honour
which is justly their due. They work for the present, and they have their
reward in their own generation.

There is another large class, whose defects in general culture and in
knowledge of the latest improvements in medicine, have been much dwelt
upon by those disposed to take gloomy views of the condition of medical
education in this country. The preliminary education of these physicians
was defective, in some cases from lack of desire for it, but in the great ma-
jority from lack of opportunity, and their work in the medical school was
confined to so much memorizing of text-books as was necessary to secure a
diploma. In the course of practice they gradually obtain from personal ex-
perience, sometimes of a disagreeable kind, a knowledge of therapeutics,
which enables them to treat the majority of their cases as successfully, per-
haps, as their brethren more learned in theory. Occasionally they contrib-
ute a paper to a journal, or a report to a medical society; but they would
rather talk than write, and find it very difficult to explain how or why they
have succeeded, being like many excellent cooks in this respect. They are

JOHN SHAW BILLINGS

honest, conscientious, hard-working men, who are inclined to place great
weight on their experience, and to be rather contemptuous of what they
call "book learning and theories." To them our medical literature is in-
debted for a few interesting observations, and valuable suggestions in
therapeutics, but for the most part, their experience, being unrecorded,
has but a local usefulness.

These three classes have been referred to simply for the purpose of call-
ing attention to the fact that, in speaking of "the physicians of the United
States," it is necessary to be careful. There are many other classes, and they
shade into each other and into empiricism in many ways. In discussions
upon this subject, it seems to be often assumed that all physicians should
possess the same qualifications, and be educated to the same standard,
which, in one respect, is like saying that they should all be six feet high, and
in another, is like the army regulations, which prescribe the same ration
and allowance of clothing for Maine and Florida, Alaska and Oregon. A
young and energetic man who has spent six years in obtaining a University
education, and four more in the study of medicine as it ought to be studied,
that is to say, in preparing himself to study and investigate for the rest of
his life, will not settle in certain districts. He has invested ten years' labour,
and from five to ten thousand dollars, and a locality which will give him a
maximum income of, perhaps, fifteen hundred dollars per annum will not
be satisfactory, in part because the capital should bring a better interest,
in part because he will have acquired tastes which will make his life un-
pleasant in such places. Yet these places must have physicians of some sort,
and it is not clear as to how they are to be supplied, if some of the universal
and extensive reforms in medical education which have been proposed
were to be enforced.

Certainly the standard for admission and for graduation at almost all
our medical schools is too low, and one-half, at least, of these schools have
no sufficient reason for existence; but it is not probable that it would im-
prove matters much to establish a uniform, which must, of course, be a
minimum, standard.

Of the material aids and instruments required for the advancement of
medical science, such as hospitals, libraries, and museums, we have ob-
tained as much as could be expected. With the proper use of those we now
possess will come the demand for, and the supply of, still better facilities
for the work of the scholar and observer.

The defects in American medicine are much the same as those observed
in other branches of science in this country, and to a great extent are due
to the same causes.

Culture, to flourish, requires appreciation and sympathy, to such an

CENTURY OF AMERICAN MEDICINE

extent, at least, that its utterances shall not seem to its audience as if in
an unknown tongue.

We have no reason to boast, or to be ashamed of what we have thus far
accomplished; it has been but a little while since we have been furnished
with the means of investigation needed to give our observations that accu-
racy and precision which alone can entitle medicine to a place among the
sciences properly so called; and we may begin the new century in the hope
and belief that to us applies the bright side of the maxim of Cousin, "It is
better to have a future than a past."

Medical Libraries in the United States

Extent of Medical Literature — Several important collections —
Cataloguing and indexing — Medical periodical literature — Theses

and inaugural addresses forming a medical library arrangement

of pamphlets necessary works of reference

It is proposed in the following sketch to give some account of the re-
sources available to the medical scholar and writer in the United States in
the way of libraries which have been formed with reference to his special
wants, and to make some remarks on the formation and care of such col-
lections.

Comparatively few persons have any idea of the amount of medical
literature in existence, or of its proper use and true value, and the result
is that the same ground is traversed over and over again. Cases are re-
ported as unique and inexplicable which, when compared with accounts
of others buried in obscure periodicals or collections of observations, fall
into their proper place and both receive and give explanation. Old theories
and hypotheses, evolved from the depths of the inner consciousness of men
too zealous or too indolent to undergo the labor of examining the works
of their predecessors, re-appear, and are re-exploded with the regular pe-
riodicity of organic life; and even when literary research is attempted, it
is too often either for controversial purposes, to serve the ends of prejudiced
criticism, or to support a charge of plagiarism, or else for the purpose of
obtaining a goodly array of foot-notes, which shall imply that the subject
is exhausted, and give a flavor of erudition to the work. This state of things
is by no means peculiar to medicine, but its literature is certainly an ex-
cellent illustration of the maxim "The thing which has been is that which
shall be, and there is no new thing under the sun."

The record of the researches, experiences, and speculations relating to
medical science during the last four hundred years is contained in be-
tween two and three hundred thousand volumes and pamphlets; and while
the immense majority of these have little or nothing of what we call
"practical value," yet there is no one of them which would not be called
for by some inquirer if he knew of its existence.

Hence, it is desirable, in this branch of literature, as in others, that in
each country there should be at least one collection embracing everything

Chapter VI, Public libraries in the United States of America; their history, condition,
and management. (U.S. Department of the Interior. Bureau of Education.) Washington,
1876. Part I. pp. 171-82.

MEDICAL LIBRARIES

that is too costly, too ephemeral, or of too little interest to be obtained and
preserved in private libraries.

When the great work of Mr. Caxton, the History of Human Error, is
written, the medical section will be among the most instructive and im-
portant, and also that for which it will be most difficult to obtain the data.

There are a number of valuable private medical libraries in this country
of from four to ten thousand volumes each. Having been collected for the
most part with reference to some special subject or department, they are
the more valuable on that account. The majority of the medical schools
also have libraries of greater or less value to the student.1

The collections relating to medicine and the cognate sciences, which are
available to the public and are of sufficient interest to require notice in
this connection, are those of Boston, Philadelphia, New York, Cincinnati,
and Washington. No one of these indeed approaches completeness, but
each supplements the other to such an extent that it seldom happens that
bibliographical inquiries cannot be answered by referring to them in suc-
cession.

MEDICAL LIBRARIES IN BOSTON

The principal medical collection in Boston is that of the Boston Public
Library, which now comprises about 11,000 volumes, for the most part
standard works and periodicals, the latter containing files of the principal
American and foreign publications. There is no separate printed catalogue
of the medical section nor of any of the medical libraries of Boston, which
fact much impairs their practical usefulness.

The Boston Athenaeum has about 5,000 volumes of medical works. The
Boston Society for Medical Improvement has 1,000 volumes of bound pe-
riodicals. The Treadwell Medical Library at the Massachusetts General
Hospital contains about 3,542 volumes. Harvard University Library, in-
cluding the library of the medical school, has between 5,000 and 6,000 vol-
umes of medicine, including some of much rarity and value.

A collection which gives promise of much usefulness is that of the Boston
Medical Library Association, which, although only about a year old, al-
ready contains about 3,000 volumes and receives the most important medi-
cal periodicals.

If the resources of Boston and vicinity in the way of medical literature
available to the student could be shown by a good catalogue indicating
where each of the several works may be found, the practical working value
of the collections would be greatly enhanced. The difficulties in the way of

1 For statistics of the principal libraries of medical schools and societies, see table at
the end of this article. — Editors.

JOHN SHAW BILLINGS

accomplishing such a desirable result, although great, do not appear to be
at all insuperable, and might be readily overcome by the conjoint action
of the medical societies and of the libraries interested. The same remark
will apply to the medical collections of New York and Philadelphia.

MEDICAL LIBRARIES IN NEW YORK

The library of the New York Hospital is the oldest and largest collection
in the city, and now contains about 10,000 volumes. It is well housed in a
building which although not fire proof is comparatively so. The books are
conveniently arranged, and there is room for twice the present number. It
receives about 100 current periodicals, but with this exception does not
contain much recent literature. An alphabetical catalogue of authors was
published in 1845; three supplementary catalogues have since been printed,
and a fourth is now in the press. The one published in 1865 is a list of the
donation of Dr. John Watson, consisting of 481 volumes of rare and valu-
able books. This library is for consultation and reference only, as no books
are loaned, and is open daily, except Sunday, from 9 a. m. to 10 p. m.

The collection of the New York Medical Library and Journal Association
now contains about 3,500 volumes, and is mainly valuable for its collection
of periodical literature. It receives about 95 current journals. No cata-
logue of this collection has been printed.

The Mott Memorial Library is free and numbers 4,700 volumes.2

The Academy of Medicine of New York City has recently taken steps to
purchase a building, with the intention of forming a library which shall
meet the requirements of so important a medical centre as New York,
and valuable aid to this end from private collections is promised, notably
from the library of Dr. S. S. Purple, which is remarkably complete in
American medical periodicals and in early American medical literature.
A large, well appointed, and well sustained medical library is much needed
in the city of New York, and it is to be hoped that the effort referred to
will be crowned with success. The library at present numbers 3,000 vol-
umes.3

2 This library was founded by the widow of the eminent surgeon, Valentine Mott, M.D.,
and is free for consultation and study to medical students and members of the profession.
Additions to the collection are made annually by Mrs. Mott and her son; the latter man-
ages its affairs. It has no permanent fund for its increase. — Editors.

3 The Medico-Legal Society of New York, organized in November, 1872, began in 1873
the formation of a special library. The following is taken from a circular published by the
president of the society in October, 1875:

"The Medico-Legal Society of New York has voluntarily assumed the labor of organ-
izing and maintaining a complete library of all accessible works upon medical juris-
prudence— especially in the English, French, and German tongues.

"There is not at the present time any notable collection of such works in the United

MEDICAL LIBRARIES

MEDICAL LIBRARIES IN PHILADELPHIA

The medical libraries of Philadelphia are large and valuable, and an
interesting account of their history and condition is given by Dr. Richard
Dunglison.4

The library of the College of Physicians has received large additions
within the last few years, and is now the most valuable working collection
in the country, with the exception of that in Washington. It numbers
more than 19,000 volumes, receives about 80 current journals, and is rich
in the early medical literature of this country. It is a reference and con-
sultation library to the public, and loans books to the members of the col-
lege. It is much to be regretted that it has no printed catalogue nor a cata-
logue of subjects in any form. It has about 5,000 volumes of medical
journals.

The Library of the Pennsylvania Hospital, numbering 12,500 volumes,
is the oldest medical collection in this country, having been begun in 1763.
The last printed catalogue, issued in 1857, is a classed catalogue with an
index of authors, on the plan of the catalogue of the Library of the Medi-
cal Society of Edinburgh, and is a valuable work for reference, which
should be in every public medical library. A supplement to it was issued in
1867.

According to Dr. Dunglison, there is a remarkable absence of duplica-
tion between this collection and that of the College of Physicians, and to-
gether they well represent the early medical literature of this country,
especially of Philadelphia imprints.

States. The great law libraries in the city and State of New York, and indeed in the
United States, have only a few standard works of this character, and there is no reason
to suppose any change is likely to occur presently in this regard. The medical libraries
of the nation are nearly as poor as are the law libraries in works upon medical juris-
prudence.

"The society, by a general resolution unanimously adopted, voluntarily assumed the
obligation on the part of each of its members, of contributing one volume per annum
to this library. A membership, which has grown from a small list to upwards of four
hundred in three years, and which bids fair to be the strongest, numerically, of any of
the kindred societies, makes this means alone likely, in time, to furnish a collection of
great value. Liberal contributions of money have also been made by individual mem-
bers, which have been invested in volumes, obtained by correspondence with all the
dealers and most of the librarians of such works throughout the world.

"A catalogue of the names of all works ever published on these subjects is in course
of preparation by members of the society, and is now far advanced towards completion."

The annual reports of the society show that up to November, 1875, the contributions
to the library had been 390 bound volumes, 121 pamphlets, besides §198 for the pur-
chase of books. — Editors.

* Philadelphia Medical Times. Reprinted, 46 pp. 8°. Philadelphia: J. B. Lippincott
& Co., 1871.

JOHN SHAW BILLINGS

Since the Medical Department of the University of Pennsylvania has
occupied its new buildings in West Philadelphia, a valuable foundation
for a medical library, consisting of about 3,000 volumes, has been pre-
sented to it by Dr. Alfred Stille, provost of the university.5

MEDICAL LIBRARIES IN CINCINNATI

In Cincinnati there is a small but valuable collection of medical books
at the City Hospital. The Mussey Medical and Scientific Library contains
about 4,000 volumes and 2,000 pamphlets, and is at present a special de-
posit in the Cincinnati Public Library.

MEDICAL LIBRARY IN WASHINGTON

The Library of the Surgeon-General's Office is deposited in the Army
Medical Museum at Washington, but may be considered as the medical
section of the Congressional, or National Library, and is managed and
catalogued in substantially the same manner as that collection. It now
numbers about 40,000 volumes and 40,000 pamphlets, or, to state it in
another form, about 70,000 titles. The library is intended to cover the en-
tire field of medical and surgical literature, and is now an excellent
foundation for a national medical library that shall be worthy of the name,
and put the writers and teachers of this country on an equality with those
of Europe so far as accessibility to the literature of the subject is concerned.

It has been formed within the last twelve years, and is of course too young
to contain many of the incunabula or the books noted as rare and very rare,
which are the delight of the bibliomaniac; nor, indeed, has any special ef-
fort been made to obtain such. Yet there are few of the ancient authors
whose works it does not possess, although not always in the most desirable
editions. It is comparatively full in American, English, French, and German
medical literature of the present century, and in works relating to surgery,
pathological anatomy, and hygiene. Of the early medical literature of this
country, that is, prior to 1800, it has but little. It possesses a few valuable
manuscripts, the oldest of which is a fine copy of the Lilium Medicinae of
Bernard de Gordon, dated 1349.6

5 This library is thus characterized by the generous donor: "The collection comprises
upwards of 3,000 volumes, including a considerable number of pamphlets. The bulk of
the library consists of American, English, French, and German periodicals. The other
works are in English, French, and German, and are chiefly medical as distinguished from
surgical." — Editors.

6 There are libraries belonging to several schools in which the Eclectic and Homeo-
pathic theories of medicine are taught, the only one of the former reported being that
of Bennett Medical College at Chicago, containing 500 volumes; and the largest of the
latter class that of the Hahnemann Medical College at Philadelphia, which numbers
2,000 volumes. The American periodical literature of neither of these schools is exten-

MEDICAL LIBRARIES

CATALOGUING AND INDEXING

For the benefit of those who are not familiar with the practical workings
of a large library, and who, therefore, do not appreciate the amount of
time and labor involved, the following account is given. It will give no
information to the skilled librarian, who will see at once many defects in
the mode of recording — due in this case to the lack of clerical force.

The working catalogue of this library is a card catalogue of the usual
form; that is, each separate work, whether it be a pamphlet of two leaves or
a cyclopaedia of fifty volumes, is catalogued on a slip of stout paper about
7 by 5 inches, giving under the name of the author the exact title of the
work, the place and date of publication and the collation, that is, the num-
ber of pages or leaves, the size or form of the book, and the number of
plates or tables. These cards are arranged in drawers, according to names
of authors in dictionary order, anonymous works forming a separate class.

sive. The following statement is from the pen of the dean of the faculty of the Eclectic
Medical Institute at Cincinnati, also editor of the Eclectic Medical Journal. He thus
sketches the history of the library of the institute:

"Beginning in 1845, it was deemed an important object to secure a good medical
library of books, both new and old, and as a nucleus of such, a private library was
purchased, at a cost of $1,500. It was a singular collection of books, both old and rare,
and yet, with a few exceptions, it was wholly worthless for the uses of the medical
student. The antiquary who desired to unearth old theories and crude methods of
treatment would have been delighted with it. To this were added, from time to time,
works of the present generation until, in 1853, some 3,000 volumes had been collected,
when, the library room being required for enlargement of the college halls, the books
were stored in a small room, and the college was without a library for five years. In 1858
changes in the building were again made, and the books were dusted, some of them re-
bound, numbered, and catalogued, and made ready for use. But still the students were
not inclined to use them, even with the aid of a nicely carpeted, lighted, and heated read-
ing room, and, after two winters of disuse, the dust was allowed to accumulate on the
books, and they rested in peace until the fire of 1870, when they were fortunately con-
sumed.

"While thus somewhat unfortunate in our general library, we have to record marked
benefit from a collection of books of a different character. In a medical college there are
often spare moments between lectures that students might improve, if books were at
hand; and quite frequently study would be much facilitated if reference could be made
to a standard authority, even for a moment. Often some important fact will have escaped
the learner's mind, which, could he recall it, would make an entire subject plain and en-
able him to meet a coming examination. A moment's reference to an authority between
lectures is sufficient, while without it there might be complete failure. Frequently an en-
tire train of thought is arrested by the want of a single fact which is an initial point; the
struggle of the mind to recall this fact is frequently sufficient to incapacitate it for the day.

"A reading room furnished with several sets of the latest text books for reference was
orovided, and with most satisfactory results. The books were in constant use.

"I believe that these working libraries are to be commended in all higher schools." —
Editors.

JOHN SHAW BILLINGS

From these cards was printed the catalogue of authors, which was com-
pleted in 1873, and makes two volumes, royal octavo, of about 1,200 pages
each, with a supplementary volume containing the anonymous works, re-
ports, periodicals, and transactions. The cards from which this was printed
were then distributed according to subjects, the subjects being arranged in
dictionary order. This forms the subject catalogue. As new books were
added a second card catalogue was carried on for them, which is known as
the supplementary catalogue.

The subject catalogue above referred to has been very greatly extended
by a process of indexing original papers in medical periodicals and trans-
actions. The preparation of this index was begun January 1, 1874, since
which date every number of current foreign medical journals and trans-
actions has been indexed as soon as received. When a number of the Lon-
don Lancet, for instance, is received, the librarian indicates in it by a slight
pencil check the articles which should be indexed. The journal is then
handed to a clerk who indexes each article checked upon one of the cata-
logue cards. The top line is left blank for the subject. Next is given the
name of the author, the title of the article, literally transcribed, or if there
be no title, one is made for it, and finally the abbreviated title of the
journal, the year, the number of the volume, and the pagination. This
mode of indexing is on the plan pursued in the Catalogue of Scientific
Papers, 1800-1863, compiled and published in six quarto volumes by the
Royal Society of London. The number of the journal, with the cards thus
prepared, is returned to the librarian, who indicates in pencil the subject
under which each card should be distributed, and the cards go to the sub-
ject catalogue. The journal receives a red stamp showing that it has been
indexed, is checked off on the register of periodicals received, and goes to
the files.

At first only foreign journals were thus indexed, it being known that
Dr. J. M. Toner, of Washington, was preparing an index of American
journals, which it is his intention to make complete to the year 1876. Upon
inquiry, however, the work of Dr. Toner was found to be on a very dif-
ferent plan, as it includes all articles, whether original or copied, while on
the other hand the titles of articles are much abbreviated.

It has therefore been thought best to index all journals, American and
foreign, beginning with January 1, 1875. At the same time as much as
possible is being done to index preceding volumes of important journals
and transactions, of which about 1,000 volumes were indexed during the
past year. This work will be continued as rapidly as possible. The statistics
shown in Table I are the total number of what may be called regular
medical journals which have been established since the first, namely, Les
Nouvelles D^couvertes sur toutes les parties de la Medecine, Paris, 1679,

MEDICAL LIBRARIES

TABLE I

Number
Begun

Number of
Volumes
Published

Number
That Did

Not Get

B eyond
the First

Volume

Number

Rep-
resented

in the
Library

Volumes
Represented
in the
Library

Current
Number
January
1, 1875

1 ft

4.Q

914.

9f>Q

1 1
1 1

o
Z

West Indies and South Amer-

Kp I nr 1 1 1 m

343

309

i yo

9 fift4
Z , Dot

1 1
1 1

l ft^fi

"ift

IrPrm 51 TIV HTlfl AllQt"¥*151

386

3,280

208

2,504

112

1 ,327

1 129

o
A

T_T_11 J

9DO

T f o l\r

671

527

Japan

168

Spain and Portugal

191

Sweden, Norway, and Den-

289

260

114

Total

1,147

10,736

218

714

8,214

254

as well as the time and labor which the making of such an index will re-
quire.

From this table it will be seen that the library now contains about 75
per cent, of all that has been published in medical journals. It would not
probably be desirable to extend an index of these farther back than 1800,
as the works of Ploucquet and Reuss fairly cover all medical periodical
literature of any importance prior to that date. A few of the journals will
be very difficult, if not impossible, to obtain; but these will be for the most
part of little practical importance. Several medical officers of the Army,
whose stations made it possible to send sets of journals to them without
too much inconvenience, have assisted in the work, and if this aid can be
continued, it is hoped that the index will be completed in about two years.
There is little doubt that it will then be printed, and it will form a valuable
contribution to medical bibliography.

Such an index is proposed in the preface to the Catalogue Raisonn£ of

JOHN SHAW BILLINGS

the Medical Society of Edinburgh, published in 1836, but Professor Mac-
lagan states that nothing has been done in this direction.7

The important part of a medical library, that which will give it character
and value, and for deficiency in which nothing can compensate, is its file
of medical journals and transactions. The difficulty of obtaining and pre-
serving these is in proportion to the importance of the matter. The ma-
jority of them are essentially ephemeral in character; small editions are
published; they are rarely preserved with care, and even when attempts
are made to preserve them by binding, it is often, and indeed usually,
without sufficient attention to the collation, so that in examining files of
old journals it will be found that at least one-half lack a leaf, a signature,
or a number. This fact causes much trouble and disappointment to the
librarian, and must always be kept in view in the collection of this class
of literature. In the attempt to make a complete collection of American
medical journals for this library, it has been repeatedly found that what
purported to be the volume or number wanting to complete a file was
defective. It is probable that there is not a complete collection in existence
at any one point, although there are two public and at least three private
collections in this country which are very full, those of the library of the
Surgeon General's Office; of the College of Physicians, of Philadelphia; of
Dr. Toner, of Washington; of Dr. Hays, of Philadelphia, and of Dr. Purple,
of New York.

The rarest American medical journals are probably some of those printed
in the West and South; for instance, the Ohio Medical Repository (1826-
'27) and the Confederate States Medical and Surgical Journal (1864-'65).

Another class of medical literature which is important to the librarian,
and the value of which is usually underestimated, consists of medical theses
and inaugural dissertations. To obtain complete series of these is even more
difficult than to get journals, for the reason that they are more ephemeral,
and because it is scarcely possible to ascertain what have been published,
or when the series may be considered complete. For a few schools, lists
have been published of the theses presented by their graduates, such as
Paris and Edinburgh, but even for Edinburgh, the only catalogue of the
theses which the writer has been able to obtain, does not show when the
regular printing of all theses ceased. Callisen has been led into error in
this way in his otherwise very complete Bibliographical Lexicon, in which
he gives the titles of many theses which were never printed, notably of the
Universities of Pennsylvania and Transylvania. The value of these theses
is fourfold. As material for the history of medicine they may be taken to
represent the theories and teaching of the school; they often contain re-

7 Edinburgh Medical Journal, January, 1873, p. 585.

MEDICAL LIBRARIES

ports of cases, or accounts of investigations made by the student under
the direction of a professor, which are of much value, and they are neces-
sary to medical biography, the more so as in most of the German universi-
ties a sketch of the life of the candidate is appended to the thesis. In addi-
tion to this, prior to the era of medical journalism, it was the custom for
the president or one of the professors to add an introduction of ten or
twelve pages to the dissertation, treating on some subject usually having
no direct relation to the thesis, and forming the sort of paper which would
now be sent to a medical journal. The number of these theses in existence
is very great; there are in the Library of the Surgeon-General's Office about
40,000.

A few words of advice to those who may be desirous of forming a public
medical library in connection with a medical school may be of some use;
at all events, they are the result of practical experience. The first thing is
to obtain works of medical bibliography, and a list of a few which will be
found the most useful is appended. In addition to these it will be neces-
sary to make arrangements to obtain regularly as published the catalogues
of medical books issued or furnished by the following booksellers:

In Boston, Schcenhof 8c Mceller, James Campbell; in New York City,
Wm. Wood 8c Co., L. W. Schmidt, B. Westermann 8c Co., E. Steiger,
Stechert 8c Wolff, F. W. Christern; in Philadelphia, H. C. Lea, Lindsay 8c
Blakiston.

The next thing is to take steps to obtain the current medical periodicals
as completely as possible, and also the current ephemeral pamphlets, such
as reports of hospitals and asylums, boards of health and health officers,
transactions of medical societies, addresses, etc. These things, as a rule,
cannot be purchased, and while they may usually be had for the asking
at the time of their publication, it will be found very difficult, if not im-
possible, to get them after a few years, or it may be only a few months, have
elapsed.

With regard to the purchase of books, so much depends on the amount
of funds available that no general advice can be given. The majority of
large works, of which there is little danger that the supply will be exhausted
for several years, should not as a rule be purchased at the time of their pub-
lication, unless they are wanted for immediate use. In a year or two they
can be obtained at a much reduced price. It will often be good economy
to buy a lot of books in bulk, even although a number of duplicates be thus
obtained, and this is especially the case at the commencement of the forma-
tion of a collection. On a small scale the same rule applies to the purchase
of bound volumes of pamphlets. All duplicates should be preserved for
purposes of exchange. It may seem hardly worth the trouble to preserve
what most physicians would throw at once into the waste-basket, but un-

JOHN SHAW BILLINGS

less this is done the library will never be a success. There need be no special
haste about the disposal of duplicates, as they increase in value with age.

PAMPHLETS

The pamphlets in the Library of the Surgeon-General's Office have been
disposed of in three ways: First, there are 760 volumes of bound pamphlets,
mostly purchased in that condition, which are for the most part classified
according to subjects; these volumes are numbered consecutively. Second,
about 2,000 pamphlets are bound in separate volumes. These are numbered
as single volumes, and include those which are considered rare or especially
valuable. The remainder of the pamphlets, including the majority of the
inaugural dissertations of the German universities, are kept in file-boxes.
These boxes are made of walnut, and the pamphlets stand in them with
their title-pages looking toward the back of the shelf, the boxes being of
widths suitable for octavos, quartos, etc. The box has no top, and the rear
end slides in and out, and can be fixed at any point. Each box will hold
about 100 pamphlets.

The boxes are arranged on shelves suited to their height, thus prevent-
ing the admission of dust. The front of the box has a ring, by which it can
be pulled out, and presents an ample surface for labeling its contents. By
loosening the rear end, which can be done by a touch, and withdrawing
it, the title of the work is before the examiner, and a pamphlet can be
added or withdrawn without disturbing the others. When a pamphlet is
required for use it is bound temporarily in stout covers, the backs of which
are pressed together by a strong spring. These covers have an enameled
card on the side, on which is written in pencil the title of the pamphlet
within. This can be readily erased to make room for the next.

The theses of the schools of Paris, Montpellier, and Strasbourg are bound
in volumes, following the usual arrangement for those schools.

With regard to binding, it is believed that the advice of the Librarian of
Congress is the best that can be given: "Bind in half turkey, and in most
cases let the color be a bright red." Binding in calf should not be used, ex-
cept to match what has already been so bound. The binding in of covers
and advertisements is an important point, and gives increased value to a
volume so bound; indeed, it is sometimes impossible to collate serial pub-
lications without the assistance of the covers.

Following is a list of works which will be found especially useful for
reference in medical bibliographical work, and which should be in every
medical library. For additional titles consult Pauly, infra, pp. 1 to 15.

Allibone, S. A. A critical dictionary of English literature and British and American

authors. 3 v. Roy. 8°. Phila., 1863-71.
Atkinson, J. Medical bibliography. 8°. London, 1834.

MEDICAL LIBRARIES

Brunet, J. C. Manuel du libraire et de l'amateur de livres. 5me £d. 6 v. Roy. 8°. Paris,
1860-'65.

Callisen, A. C. P. Medicinisches Schriftsteller Lexicon der jetzt lebenden Arzte, Wun-
darzte, Geburtshelfer, Apotheker, und Naturforscher aller gebildeten Volker. 33 v.
8°. Copenhagen, 1830-45.
Haller, A. v. Bibliotheca anatomica. 2 v. 4°. Tiguri, 1774— "77.
— Bibliotheca chirurgica. 2 v. 4°. Bernae, 1774-75.
— Bibliotheca medicinae practicae. 4 v. 4°. Basiliae et Bernae, 1776— '88.
Pauly, A. Bibliographic des sciences medicales. 8°. Paris, 1872-74.

Ploucquet, W. G. Literatura medica digesta; sive, Repertorium medicinae practicae,

chirurgiae atque rei obstetricae. 4 v. 4°. Tubingae, 1808-9.
Roy, C. H. a. Catalogus bibliothecae medicae. 5 v. 8°. Amst., 1830.

Watt, R. Bibliotheca Britannica; or a general index to British and foreign literature.
4 v. 4°. Edinburgh, 1824.

Catalogue raisonne of the Medical Library of the Pennsylvania Hospital, by Emil.
Fischer, xxvi, 750 pp. 8°. Philadelphia, 1857.

Catalogue of the library of the New York Hospital, arranged alphabetically and analyti-
cally. 194 pp. 8°. New York, 1845. [With supplements to the same published in 1861,
1865, and 1867.]

Catalogue of the library of the Surgeon-General's Office, United States Army, with an
alphabetical index of subjects. 2 p. 1., 454 pp. Roy. 8°. Washington, D.C., 1872.

Catalogue of the library of the Surgeon-General's Office, United States Army. 3 v. Roy.
8°. Washington, 1873-74.

Classed catalogue of the library of the Royal College of Surgeons of London, lxii, 1171
pp. 8°. London, 1843.

Catalogue of the Royal Medical and Chirurgical Society of London, vii, 762 pp. 8°. Lon-
don, 1856.

Index to the above, vii, 293 pp. 8°. London, 1860.

Bibliotheque imperiale, department des imprimes. Catalogue des sciences medicales.

Vols. 1 and 2. hi, 794 pp., 1 1.; 778 pp., 1 1. Imp. 4°. Paris, 1857 and 1873.
Rozier, Victor. Essai d'une bibliographic universelle de la medecine, de la chirurgie, et

de la pharmacie militaires. 234 pp. 8°. Paris, 1862.
Dictionnaire des sciences medicales; biographie medicale. [Par A. J. L. Joardan.] 7 v. 8°.

Paris, C. L. F. Panckoucke, 1820-25.
Reuss, J. D. Repertorium commentationum a societatibus litterariis editarum. Tomes

X-XV. Scientia et ars medica et chirurgica. 6 v. 4°. Gottingae, 1813— '20.
Englemann, Wm. Bibliotheca medico chirurgica et anatomico-physiologica. Alpha-

betisches Verzeichniss der medicinischen. . . . Bucher welche vom Jahre 1750 bis 1847

in Deutschland erschienen sind. 734 pp. 8°. Supplement Heft 1848-67. 350 pp. 8°.

Leipzig, 1848-68.

Catalogue of scientific papers, (1800-1863.) Compiled and published by the Royal So-
ciety of London. 6 v. 4°. London, 1867-72.

JOHN SHAW BILLINGS

Table of the Principal Medical Libraries in the United States
[For further information respecting the following and other medical libraries in
the United States see general table of statistics elsewhere in this report.]

Place

Connecticut
New Haven

Dist. of Columbia
Washington

Georgia

Augusta

Savannah
Illinois

Chicago
Kentucky

Lexington

Louisville

Louisiana
New Orleans

Maine

Brunswick
Massachusetts

Boston

Salem
Worcester
New York
Albany
New York
New York
New York

New York
Syracuse
Utica
Ohio

Cincinnati
Cincinnati
Cleveland

Name

Medical Institution of Yale College

Surgeon-General's Office, United States
Army

Medical College of Georgia
Savannah Medical College

Chicago College of Pharmacy

Transylvania Medical College of Kentucky
University

University of Louisville, Medical Depart-
ment

University of Louisiana, Medical Depart-
ment

Medical School of Maine

Harvard University Medical School
Medical Library Association of Boston
Treadwell Library, Massachusetts General
Hospital

Essex South District Medical Society
Worcester District Medical Society

Albany Medical College

Academy of Medicine

Medical Library and Journal Association

Mott Memorial Free Medical and Surgical

Library
New York Hospital
College of Physicians and Surgeons
New York State Lunatic Asylum

Cincinnati Hospital
Medical College of Ohio
Cleveland Medical College

Date of
Origin

1812
1865

1831
1853

1859

1837

1834

1820

1782
1875
1857

1805
1798

1839
1846
1864
1867

1796
1872
1814

1870
1819
1843

MEDICAL LIBRARIES 89

Table of the Principal Medical Libraries in the United States — Continued

Place

Name

Date of
Origin

Number
of

Volumes

Pennsylvania

Philadelphia

College of Physicians

1789

18,753

Philadelphia

Hahnemann Medical College

1867

2,000

Philadelphia

Pennsylvania Hospital

1763

12,500

Philadelphia

Philadelphia College of Pharmacy

1821

2,350

Philadelphia

University of Pennsylvania, Medical De-

1765

3,000

partment

Rhode Island

Providence

Rhode Island Hospital

1868

2,000

° The library contains in addition to the bound volumes, a collection of 40,000
pamphlets relating to medicine and surgery.

The Medical Journals of the United States

The Boston Medical and Surgical Journal has now been issued for fifty
years, and it is thought that some account of the medical journals which
have appeared in this country to the present time will form a fitting and
useful introduction to what it is hoped will prove to be the second half
century of its existence.

The first number of this journal is dated February 19, 1828, and formed
the continuation and consolidation of the New England Journal of Medi-
cine and Surgery and the Boston Medical Intelligencer, the particulars with
regard to which will be found in the list to be given at the end of these
remarks.

The first editors of this journal were Drs. J. C. Warren, W. Channing,
and John Ware. After these came Dr. Chandler Robbins and Dr. James
Wilson, and in Vol. XL, 1835, the name of Dr. J. V. C. Smith appears on
the title-page (Ms. note of Dr. B. E. Cotting), the publication of the jour-
nal at the same time passing into the hands of Mr. D. Clapp as publisher.

At the time of its commencement there were in existence in the United
States eight medical journals, namely: in Philadelphia, The American
Journal of the Medical Sciencies, The American Medical Recorder, The
Monthly Journal of Foreign Medicine, The North American Medical and
Surgical Journal, and The Philadelphia Monthly Journal of Medicine and
Surgery (which ceased February 28, 1828); in New York, The New York
Medical and Physical Journal; in Cincinnati, The Western Medical and
Physical Journal; and in Lexington, Ky., the Transylvania Journal of
Medicine and the Associate Sciences.

Prior to this time thirty-one medical journals had been commenced in
the United States, twenty-three of which had suspended or merged in other
journals.

Table 1 shows by quinquennial periods the number of medical journals
which have commenced and ceased in this country, excluding those de-
voted to pharmacy and dentistry.

The mortality statistics of our medical journals as shown in Table 2 will
be found interesting.

Tables 1 and 2, if examined in connection with the following list

Boston Medical and Surgical Journal 100: 1-14 (January 2, 1879) An errata note,
published in the same journal, issue of January 16, 1879 (v. 100, p. 108), has here been
incorporated.

MEDICAL JOURNALS

Table 1

Years, Both Inclusive

Regular

Homoeopathic

Botanic

Eclectic

Begun

Closed

Begun

Closed

Begun

Closed

Begun

Closed

1797-1802

1803-1807

1808-1812

1813-1817

1818-1822

1823-1827

1828-1832

1833-1837

1838-1842

1 £14.7

1 7
1 /

•j

<x
o

1848-1852

1853-1857

1858-1862

1863-1867

1868-1872

1873-1877

1878

Total

250

196

Table 2

No. of
Titles
Commenced

No. of Vols.
Commenced

Only One
No. Issued

Vol. I Not
Completed

No. That
Did Not
Go Beyond
Vol. I

Not
Beyond
Vol. II

Cur-
rent,
Novem-
ber, 1878

Regular

247

1630

Homoeopathic

214

169

124

431

Pharmaceutical

167

187

198

of our medical journals as arranged by States, afford abundant material
for comment and reflection, but it is believed that the limited space avail-
able can be more usefully employed in giving the list referred to than in
pointing out the errors of those who are responsible for the existence of
such a list. It is as useless to advise a man not to start a new journal as it
is to advise him not to commit suicide.

As I have elsewhere remarked, the motive for the existence of the minor

JOHN SHAW BILLINGS

journals is not for direct profit, but as an indirect advertisement, or — and
this is more common — the desire to have a place in which the editor can
speak his mind and attack his enemies without restraint. How shall the
would-be journalist be persuaded that no one except his personal acquain-
tances will care anything about his opinions, his praise, or his blame?

It will be found interesting to compare the geographical distribution of
this class of publications, and to inquire why, for instance, Baltimore medi-
cal journals are so short-lived, why New England has produced so few in
comparison with Ohio and Kentucky, etc., etc.

List of Medical Journals of the United States Arranged by States

Arkansas.

The Arkansas Medical Record. Monthly. Conducted by J. I. Hale. Little
Rock. Nos. 1-4, Vol. I. January to April, 1878. 8vo.

California

The San Francisco Medical Journal. W. H. Miller, Editor. San Francisco.
No. 1, Vol. I. January, 1856. 8vo.

The California State Medical Journal. Quarterly. J. F. Morse, Editor.
Sacramento. Vol. I. July, 1856, to April, 1857. 8vo.

The Marysville Medical and Surgical Reporter. Quarterly. L. Hubbard
and H. W. Teed, Editors. San Francisco. No. 1, Vol. I. November, 1858.
8vo.

The Pacific Medical and Surgical Journal. Monthly. Edited by J. B.
Trask and others. San Francisco. Vols. I.-IX. 1858-67. New Series, Vols.
I.-XI. 1867-78. 8vo. Current. In 1865 absorbed the following, and added
the words "and Press" to its title.

The San Francisco Medical Press. Quarterly. Edited by E. S. Cowper.
San Francisco. Vols. I.-IV. 1860-65. 8vo. Consolidated with the preceding.

The California Medical Gazette. Monthly. Edited by T. Bennett and
others. San Francisco. Vols. I.-II. July, 1868, to August, 1870. 4to.

The Western Lancet. Monthly. Edited by E. Trenor and others. San
Francisco. Vols. I.-VII. 1872-78. 8vo.

Connecticut

The Monthly Journal of Medicine. Hartford. Conducted by an associa-
tion of physicians. Vols. I.-VI. January, 1823, to December, 1825. 8vo.

The American Annals of the Deaf and Dumb. Quarterly. Edited by L.
Ray and others. Hartford. Vols. I.-XX1II. 1847-61. Washington D C
1868-78. 8vo.

The Quarterly Journal of Inebriety. Hartford. Vols. I.-II. 1876-78. 8vo.

MEDICAL JOURNALS

District of Columbia

The Register and Library of Medical and Chirurgical Science. Weekly.
Edited by G. S. Pattison and J. Hagan. Washington. Vols. I.-II. 1833-36.
8vo. Vol. II. ends abruptly with page 440.

The National Medical Journal. Quarterly. Washington. Edited by C. C.
Cox and others. Vols. I.-II. 1870-72. Became monthly in Vol. II. No. 10,
Vol. II., last published.

National Medical Review. Walter S. Wells, Editor. Monthly. Vol. I. No.
1. December, 1878. Washington, D. C. 8vo.

Georgia

The Southern Medical and Surgical Journal. Monthly. Edited by M.
Antony and J. A. Eve. Augusta. Vols. I -III. 1836-39. New Series. Vols. I-
XVII. 1845-61. Third Series. Vol. I. 1866-67. 8vo.

The Georgia Blister and Critic. Monthly. Edited by H. A. Ramsay and
W. T. Grant. Atlanta. Vol. I., and No. 1, Vol. II. 1854-55. 8vo.

Atlanta Medical and Surgical Journal. Monthly. Edited by J. P. Logan,
W. F. Westmoreland, and others. Atlanta. Vols. I-XVII. 1855-61, 1866-78.
8vo.

The Oglethorpe Medical and Surgical Journal. Bi-Monthly. H. L. Boyd
and others, Editors. Savannah. Vols. I.— III. 1858-61. 8vo.

The Savannah Journal of Medicine. Bi-Monthly. Edited by J. S. Sulli-
van. R. D. Arnold, and others. Savannah. Vols. I.-IV. 1858-61. New Series,
Vol. V. 1866. 8vo.

The Georgia Medical and Surgical Encyclopaedia. Monthly. Edited by
H. N. Hollifield and T. W. Newsome. Sandersville. Nos. 1-8, Vol. I. May
to December, 1860. 8vo.

The Semi-Monthly Medical and Surgical Repertory. Edited by E. F.
and J. J. Knott. Griffin, Ga. Nos. 1-4, Vol. I, 1871. 8vo.

The Georgia Medical Companion. Monthly. Edited by T. S. Powell and
W. T. Goldsmith. Atlanta. Vols. I-II. 1871-72. 8vo. Continued as the fol-
lowing.

The Southern Medical Record. Monthly. Atlanta. Vols. III.-VIII. 1873-
78. 8vo. Continuation of preceding.

Illinois

The Illinois Medical and Surgical Journal. Monthly. Edited by J. V. Z.
Blaney. Chicago. Vols. I.-II. 1844-46. 8vo. Continued as the following.

The Illinois and Indiana Medical and Surgical Journal. Bi-Monthly.
Edited by J. V. Z. Blaney, D. Brainard, and others. Chicago. Vols. I.-II.
1846-48. 8vo. Continuation of the preceding, and continued as the follow-
ing.

JOHN SHAW BILLINGS

The Northwestern Medical and Surgical Journal. Bi-Monthly. Edited
by W. B. Herrick and J. Evans. Chicago. Vols. V.-XIV. 1848-57. 8vo. Con-
tinuation of the preceding, and continued as the following.

The Chicago Medical Journal. Monthly. Edited by N. S. Davis and W.
H. Byford. Chicago. Vols. XV-XXXI. 1858-75. 8vo. Continuation of the
preceding, and consolidated with the Medical Examiner, Chicago, forming
the following. Vols. XXV. and XXVI. Semi-Monthly.

The Chicago Medical Journal and Examiner. Edited by W. H. Byford
and others. Chicago. Vols. XXXII.-XXXVII. 1875-78. 8vo. Current.
Formed by the consolidation of the preceding with the Chicago Medical
Examiner.

The Northwestern Medical Intelligencer. Bi-Monthly. Chicago, 1851.
8vo. This alternated with the Northwestern Medical and Surgical Journal,
of which it formed a part.

The Chicago Medical Examiner. Monthly. Edited by N. S. Davis, and

E. A. Steele. Chicago. Vols. I -XII. 1860-71. 8vo. Continued as the follow-
ing.

The Medical Examiner. Chicago. Semi-Monthly. Edited by N. S. and

F. H. Davis. Vols. XIII.-XVI. 1872-75. 4to. In September, 1875, united
with The Chicago Medical Journal, forming The Chicago Medical Jour-
nal and Examiner.

The Military Tract Medical Reporter. L. S. and C. A. Lambert. Gales-
burg, 111. Prospectus issued in August, 1871, but the journal never ap-
peared.

The Chicago Journal of Nervous and Mental Disease. Edited by J. S.
Jewell and others. Chicago. Vols. I.— II. 1874-75. 8vo. Continued as the fol-
lowing.

The Journal of Nervous and Mental Disease. Edited by J. S. Jewell and
others. Chicago. Vols. I -III., New Series. 1876-78. 8vo. Continuation of
the preceding.

The Medical Register and Advertiser. Quarterly. Edited by J. I. Hale.
Anna, 111. Nos. 1-2, Vol. I. 1875. 8vo.

The Monthly Journal of the Southern Illinois Medical Association.
Edited by C. W. Dunning and H. Wardner. Cairo. Vols. I.-II. 1877-78.
Vol. I. in six numbers. Current.

The Illinois Medical Recorder. Monthly. Edited by R. E. Beach. Pub-
lished under the auspices of the District Medical Society of Central Illi-
nois. Nos. 1-6. June to November, 1878. 8vo. Current.

The American Medical Review and Index. Monthly. James I. Hale,
Editor. Anna, 111. Nos. 1-6. July to December, 1878. 8vo. Current.

MEDICAL JOURNALS

Indiana

The Indiana Medical Journal. Quarterly. Edited by W. H. Byford and
H. Ronalds. Evansville. No. 1, Vol. I. 1854. 8vo. Running title of first
signature is The Evansville Medical Journal, etc.

The Indiana Journal of Medicine and Surgery. Monthly. Edited by J.
Jackson and T. W. Forshee. Madison. No. 1, Vol. I. 1855. 8vo.

The Indiana Journal of Medicine. Monthly. Edited by T. M. Stevens
and others. Indianapolis. Vols. I.-VI. 1870-75. 8vo. After September, 1875,
united with The Cincinnati Lancet and Observer.

The Western Retrospect of Medicine and Surgery. Monthly. Edited by
H. M. Harvey, H. A. Lewis, and others. Evansville. Vol. I. January to
December, 1872. 8vo.

Iowa

The Western Medico-Chirurgical Journal. Monthly. Edited by J. F.
Sanford and S. G. Armor. Keokuk. Vols. I.-IL 1850-53, No. 1, Vol. III.
1854. 8vo.

The Iowa Medical Journal. Monthly. Edited by J. C. Hughes and W. R.
Marsh. Keokuk. Five volumes. 1853-69. 8vo.

The Iowa Catlin. Monthly. Edited by E. Lawrence. Osceola, Iowa. Nos.
1 and 2. April and May, 1878. 8vo.

Kansas

The Leavenworth Medical Herald. Monthly. Edited by C. A. Logan, T.
Sinks, and others. Leavenworth. Vols. I.— III. 1867-70. 8vo. Continued as
the following.

The Leavenworth Medical Herald and Journal of Pharmacy. Leaven-
worth. Vols. IV.-V. 1870-72. 8vo. Continuation of the preceding and suc-
ceeded by the following.

The Medical Herald. Leavenworth. Vols. VI.-IX. 1872-75. 8vo. Con-
tinuation of the preceding.

Kentucky

The Transylvania Journal of Medicine and the Associate Sciences. Quar-
terly. Edited by J. E. Cooke and C. W. Short. Lexington, Ky. Vols. I.-XII.
1828-39. 8vo.

The Louisville Journal of Medicine and Surgery. Quarterly. Edited by
L. P. Yandell, H. Miller, and others. Louisville. Nos. 1 and 2, Vol. I, 1838.
8vo. January, 1840, revived, and consolidated with the Western Journal of
the Medical and Physical Sciences, forming the following.

JOHN SHAW BILLINGS

The Western Journal of Medicine and Surgery. Monthly. Edited by D.
Drake and L. P. Yandell. Louisville. Thirty-two volumes. 1840-55. 8vo.

The Louisville Review. Monthly. Edited by S. D. Gross and T. G.
Richardson. Louisville. Vol. I. 1856. 8vo. Continuation of the preceding.
In January, 1857, united with The Medical Examiner, Philadelphia, form-
ing the North American Medico-Chirurgical Review.

The Western and Southern Medical Recorder. Monthly. Edited by J. C.
Cross. Lexington. Vol. I. 1841-42. Nos. 1-4. Vol. II. 1843. 8vo. Merged in
the Western Lancet.

The Transylvania Medical Journal. Bi-Monthly. Edited by E. L. Dudley.
Five volumes. 1849-54. Lexington and Louisville. Vol. III. is Vol. I. New
Series. Title, The Kentucky Medical Recorder.

The Louisville Medical Gazette. Bi-Weekly. Edited by L. J. Frazee.
Louisville. Nos. 1-7, Vol. I. 1859. 8vo.

The Semi-Monthly Medical News. Edited by S. M. Bemiss and J. W.
Benson. Louisville. Vols. I.-III. 1859-60. 8vo. Vols. II. and III. Title, The
Monthly Medical News.

The Louisville Medical Journal. Monthly. Edited by T. W. Colescott.
Louisville. Nos. 1-6. Vol. I. 1860. 8vo.

The Richmond and Louisville Medical Journal. Monthly. E. S. Gaillard,
Editor. Louisville. Vols. VI.-XXVI. 1868-78. 8vo. Continuation of the
Richmond Medical Journal.

The American Practitioner. Formerly Western Journal of Medicine.
Monthly. Edited by D. W. Yandell and T. Parvin. Louisville. Vols. I-
XVIII. 1870-78. 8vo. Current.

The Louisville Medical Reporter. Weekly. Edited by J. L. Cook and
others. Henderson. No. 1, Vol. I. 1874. 8vo.

The American Medical Weekly. E. S. Gaillard, Editor. Louisville. Vols.
I.-IV. 1874-76. 8vo. Continued as the following. Vol. II is paged consecu-
tively with Vol. I.

The American Medical Bi-Weekly. E. S. Gaillard, Editor. Louisville.
Vols. VI.-IX. 1877-78. 8vo. Continuation of the preceding.

The Louisville Medical News. Weekly. Edited by R. O. Cowling and
others. Louisville. Vols. I.-VL 1876-78. 8vo. Current.

Louisiana

Journal de la Societe- Medicale de la Nouvelle Orleans. Quarterly. Drs.
Fortin, Daret, and others. New Orleans. Annee I. 1839. 8vo.

The New Orleans Medical Journal. Bi-Monthly. Edited by E. D. Fenner
and A. Hester. New Orleans. Vol. I. 1844-45. 8vo. Continued as the follow-
ing.

The New Orleans Medical and Surgical Journal. Bi-Monthly. Edited

MEDICAL JOURNALS

by W. M. Carpenter, E. D. Fenner, and others. New Orleans. Vols. II.-XX.
1845-61 and 1866-67. 8vo. Consolidated with the Southern Journal of the
Medical Sciences, forming the following.

The New Orleans Journal of Medicine. Quarterly. Edited by S. M.
Bemiss and W. S. Mitchell. New Orleans. Vols. XXI.-XXIII. 1868-70. 8vo.
Continued as the following in 1873.

The New Orleans Medical and Surgical Journal. New Series. Bi-Monthly.
Edited by S. M. Bemiss. New Orleans. Vols. I.-IV. 1873-78. 8vo. Current.

The Louisiana Medical and Surgical Journal. Title of a periodical pro-
jected in 1845, but never issued, the New Orleans Medical and Surgical
Journal taking its place.

The New Orleans Monthly Medical Register. Edited by A. E. Axon.
Vols. I.-IL 1851-53. 8vo. In March, 1854, merged in The New Orleans
Medical News and Hospital Gazette.

L'Union Medicale de la Louisiane. Monthly. C. Delery, Editor. New
Orleans. Vol. I. 1852. 8vo.

The New Orleans Medical News and Hospital Gazette. Semi-Monthly.
Edited by S. Choppin, C. Beard, and others. New Orleans. Vols. I.-VII.
1854-61. 8vo. Continued as the following.

The New Orleans Medical Times. Monthly. Edited by A. Peniston.
New Orleans. Nos. 1-3. 1861. 8vo. Continuation of the preceding.

Journal de la Societe Medicale de la Nouvelle Orleans. Monthly. Edited
by Dr. Thiery. Vol. I. Nos. 1-8, Vol. II. 1859-61.

The New Orleans Medical Record. Semi-Monthly. Edited by B. Dowler
and S. R. Chambers. New Orleans. Nos. 1-4, Vol. I. 1866. Royal 8vo.

The Southern Journal of the Medical Sciences. Quarterly. E. D. Fenner,
D. W. Brickell, and others. New Orleans. Vols. I.-II. 1866-67. 8vo. In
January, 1868, consolidated with the New Orleans Medical and Surgical
Journal, forming the New Orleans Journal of Medicine.

Maine

The Journal of the Medical Society of the State of Maine. Hallowell.
No. 1, Vol. I. January, 1834. 8vo.

The Maine Medical and Surgical Reporter. Monthly. Edited by W. R.
Richardson and R. W. Cummings. Portland. Vol. I. 1858-59. 8vo.

Maryland

The Baltimore Medical and Physical Recorder. Quarterly. Conducted
by T. Watkins. Baltimore. Vol. I., and No. 1 of Vol. II. 1808-09. 8vo.

The Baltimore Medical and Philosophical Lyceum. Quarterly. Edited
by N. Potter. Baltimore. One volume. 1811. 8vo.

JOHN SHAW BILLINGS

The Vaccine Inquirer. Monthly. Baltimore. No. 1, February, 1822; No.
4, May, 1822; No. 5, 1824. Announced as monthly, but published at ir-
regular intervals.

The Baltimore Philosophical Journal and Review. Quarterly. Edited by
J. B. Davidge. Baltimore. No. 1. July, 1823. 8vo.

The Maryland Medical Recorder. Quarterly. Edited by H. G. Jameson.
Baltimore. Vols. I.-III. 1829-32. 8vo.

The Baltimore Monthly Journal of Medicine and Surgery. Edited by
N. R. Smith. Baltimore. One volume. 1830-31. 8vo.

The Baltimore Medical and Surgical Journal and Review. Quarterly.
Edited by E. Geddings. Baltimore. Vols. I.-II. 1833-34. 8vo. Continued
as the following.

North American Archives of Medical and Surgical Science. Monthly.
Edited by E. Geddings. Baltimore. Vols. I.-II. 1834-35. 8vo. Continuation
of the preceding.

The Maryland Medical and Surgical Journal and Official Organ of the
Medical Department of the Army and Navy of the United States. Quar-
terly. Baltimore. Vols. I.-III. 1840-43. 8vo.

The Baltimore Journal of Medicine. Bi-Monthly. Edited by E. Warren.
Baltimore. Nos. 1-3, Vol. I. January to May, 1861. 8vo.

The Medical Bulletin. Semi-Monthly. Edited by E. Warren. Baltimore.
Vols. I.-II. 1868-70. Folio. In 1871 merged in the following.

The Baltimore Medical Journal. Monthly. Edited by E. L. Howard
and T. S. Latimer. Baltimore. Two volumes. 1870-71. 8vo. In Vol. II.
title changed to Baltimore Medical Journal and Bulletin. In January, 1871,
the Bulletin merged in this.

The Baltimore Physician and Surgeon. Monthly. Baltimore. Vols. I.-VI.
1872-76. 4to. The title of Vol. I., 1872-73, was The Physician and Surgeon.

Maryland Medical Journal. Monthly. H. E. T. Manning and T. A.
Ashby, Editors. Baltimore. Vols. I.-III. 1877-78. 8vo. Current.

Massachusetts

The New England Journal of Medicine and Surgery and the Collateral
Branches of Science. Quarterly. Boston. Vols. I.-XVI. 1812-27. 8vo. Con-
tinued as The Boston Medical and Surgical Journal. Vol. XVI., title, New
England Medical Review and Journal.

The Boston Medical Intelligencer. Weekly. Edited by J. V. C. Smith.
Boston. Five volumes. 1823-28. 4to. Continued as The Boston Medical and
Surgical Journal.

The Boston Medical and Surgical Journal. Boston. Weekly. Ninety-nine
volumes. 1828-78. 8vo. Current. Formed by consolidation of the two pre-
ceding.

MEDICAL JOURNALS

American Journal of Foreign Medicine. Monthly. Conducted by an as-
sociation of physicians. Boston. No. 1, Vol. I. June, 1827.

The Monthly Journal of Medical Literature and American Students'
Gazette. Edited by E. Bartlett. Boston and Lowell. Nos. 1-3, Vol. I. Janu-
ary to March, 1832. 8vo.

The Medical Magazine. Monthly. Edited by A. L. Pierson, J. B. Flint,
E. Bartlett, and others. Boston. Three volumes. 1832-35. 8vo.

The American Medical Almanac. Annual. Edited by J. V. C. Smith.
Boston. Two volumes. 1839-40. 12mo.

The New England Quarterly Journal of Medicine and Surgery, Edited
by C. E. Ware and S. Parkman. Boston. Vol. I. 1842-43. 8vo.

The Medical World. Weekly. Edited by J. V. C. Smith and E. S. Smith.
Boston. Two volumes. 1856-57. 4to.

The Berkshire Medical Journal. Monthly. Edited by W. H. Thayer
and R. C. Stiles. Pittsfield. One volume. 1861. 8vo.

The Journal of the Gynaecological Society of Boston. Monthly. Edited
by W. Lewis, H. R. Storer, and G. H. Bixby. Boston. Seven volumes. 1869-
72. 8vo.

Michigan

The Peninsular Journal of Medicine and the Collateral Sciences.
Monthly. Edited by E. Andrews, A. B. Palmer, and others. Ann Arbor and
Detroit. Vols. I -V. 1853-58. 8vo. Continued as The Peninsular and Inde-
pendent Medical Journal.

The Medical Independent and Monthly Review of Medicine and Sur-
gery. Edited by H. Goadby and others. Detroit. Three volumes. 1856-58.
8vo. Continued as The Peninsular and Independent Medical Journal.

The Peninsular and Independent Medical Journal. Monthly. Edited
by A. B. Palmer, M. Gunn, and F. Stearns. Detroit. Vols. I.-II. 1858-60.
8vo. Formed by consolidation of the two preceding in April, 1858.

The Detroit Review of Medicine and Pharmacy. Monthly. Edited by
G. P. Andrews and others. Detroit. Vols. I.-IX. 1866-76. 8vo. Merged in
The Detroit Medical Journal.

The Michigan University Medical Journal. Monthly. Conducted by the
faculty of the medical department. Ann Arbor. Three volumes. 1870-73.
8vo.

The Western Medical Advance and Progress of Pharmacy. Quarterly.
W. H. Lathrop, Editor. Detroit. Vols. I.-II. June, 1871, to June 1873. 4to.

The Peninsular Journal of Medicine. Monthly. Edited by H. F. Lyster
and others. Detroit. Four volumes. 1873-76. 8vo. Consolidated with The
Detroit Review of Medicine and Pharmacy, forming the following.

The Detroit Medical Journal. Monthly. Edited by L. Connor and others.

100

JOHN SHAW BILLINGS

Detroit. New Series. Vol. I. 1877. 8vo. Consolidation of The Peninsular
Journal of Medicine with The Detroit Review of Medicine and Pharmacy.

The Detroit Lancet. Monthly. Edited by H. A. Cleland and L. Connor.
Detroit. Vol. I. 1878. 8vo. Current.

The Michigan Medical News. Semi-Monthly. J. J. Mulheron, Editor.
Detroit. Vol. I. 1878. 8vo. Current.

Minnesota

The Northwestern Medical and Surgical Journal. Monthly. Edited by
W. B. Herrick and J. Evans. St. Paul. Vols. I.-IV. 1870-74. 8vo.

Missouri

The St. Louis Medical and Surgical Journal. Monthly. Edited by M. L.
Linton, W. M. McPheeters, and others. St. Louis. Nos. 1-9, 11, 12. Vol. I.
1843-44. No. 12, Vol. II. 1844-45. Vols. III.-XIX. 1845-61. Also, New
Series. Vols. III.-XV. 1866-78. 8vo. In September, 1848, The Missouri
Medical and Surgical Journal was united with this.

The Missouri Medical and Surgical Journal. Monthly. Edited by R. F.
Stevens, J. N. McDowell, and others. St. Louis. Vols. I.-IV. 1845-48. 8vo.
In September, 1848, merged in the preceding.

The St. Louis Probe. Monthly. Edited by H. J. Coons and J. R. Atkin-
son. St. Louis. Vol. I. 1850. 8vo.

The St. Joseph Journal of Medicine and Surgery. Bi-Monthly. Edited
by J. H. Crane, O. B. Knode, and others. St. Joseph. Nos. 4, 5, Vol. I.,
March, May, 1859. Nos. 1, 2, 4, 5, Vol. II. September, November, 1859,
March, May, 1860. Nos. 1-3, Vol. III., September, 1860, to January, 1861.
8vo.

The Kansas City Medical and Surgical Review. Bi-Monthly. G. M. B.
Maughs and T. C. Case, Editors. Kansas City, Mo. One volume. 1860. 8vo.

The Medical and Surgical Pioneer. Monthly. Edited by J. Keller. Kansas
City, Mo. Nos. 1, 2, Vol. I. 1866. 8vo.

The St. Louis Medical Reporter. Semi-Monthly. Edited by J. S. B.
Alleyne, O. F. Potter, and others. St. Louis. Vols. I.-IV. 1866-69. 8vo.
Merged in The Medical Archives.

The Humboldt Medical Archives. Monthly. Edited by M. E. Pallen,
E. F. Smith, A. Hammer, and others. St. Louis. Vol. I., in six numbers.
September, 1867, to February, 1868. Vol. II., in ten numbers, March to
December, 1868. Vol. III., in twelve numbers, January to December, 1869.
Vol. IV., in six numbers, January to June, 1870. Vol. V., in six numbers,
September, 1870, to February, 1871. Vol. VI, in six numbers, March to
August, 1871. Vol. VII., in six numbers, September, 1871, to February,
1872. Vol. VIII., in ten numbers, March to December, 1872. Vol. IX., in

MEDICAL JOURNALS

101

five numbers, January to May, 1873. After Vol. II., title, The Medical
Archives. In September, 1869, the preceding merged in this.

The Kansas City Medical Journal. Bi-Monthly. Edited by A. P. Lank-
ford and others. Kansas City, Mo. Vols. I.-V. 1871-75. 8vo. Became monthly
with Vol. IV.

Missouri Clinical Record. Monthly. Edited by W. A. Hardaway. St.
Louis. Vol. I. 1874-75. 8vo. Continued as the following.

St. Louis Clinical Record. Monthly. Edited by W. A. Hardaway. St.
Louis. Vols. II.-IV. 1875-78. 8vo. Current. Continuation of the preceding.

New Hampshire

The New Hampshire Journal of Medicine. Monthly. Edited by E. H.
Parker. Concord. Vols. I.-VIII. 1850-58. 8vo. Vols. VI.-VIIL, published
at Manchester.

New Jersey

The New Jersey Medical Reporter and Transactions of the New Jersey
Medical Society. Quarterly. Edited by Joseph Parrish. Burlington. Vols.
I.-VIII. 1847-55. 8vo. Vol. V. became monthly. Continued as the following.

The Medical and Surgical Reporter. Monthly. Edited by S. W. Butler.
Burlington, N. J., and Philadelphia. Vols. IX.-XI. 1856-58. 8vo. Vol. XL,
and continuation published at Philadelphia. Current.

New York

A Journal of the Practice of Medicine, Surgery, and Pharmacy in the
Military Hospitals of France. Published by order of the king. Reviewed and
digested by M. De Home. Translated by Joseph Browne. No. 1, Vol. I.
New York. No date. 1783 or 1790.

The Medical Repository. Quarterly. Conducted by S. L. Mitchell, E.
Miller, and E. H. Smith. New York. Vols. I.-XXIII. 1797-1824. 8vo. Slight
change of title.

The New York Medical and Philosophical Journal and Review. Semi-
Annual. New York. Vols. I.-III. 1809-11. 8vo.

The American Medical and Philosophical Register. Quarterly. Con-
ducted by David Hosack and John W. Francis. New York. Vols. I.-IV.
1810-14. 8vo. Two editions of Vol. I.

The New York Medical Magazine. Annual. Edited by V. Mott and H.
M. Onderdonk. New York. Vol. I. (in two numbers). 1814-15. 8vo.

The Medical and Surgical Register. Edited by J. Watts, Jr., V. Mott,
and A. H. Stevens. New York. Vol. I. 1818-20. 8vo.

The New York Medical and Physical Journal. Quarterly. Edited by
J. W. Francis and others. New York. Vols. I.-IX. 1822-30. 8vo.

102

JOHN SHAW BILLINGS

The New York Monthly Chronicle of Medicine and Surgery. By an As-
sociation of Physicians. New York. Vol. I. 1824-25. 8vo.

The New York Medical Journal. Quarterly. Conducted by D. L. M.
Peixotto, J. R. Rhinelander, and J. J. Graves. New York. Two volumes.
1830-31. 8vo.

The New York Medico Chirurgical Bulletin. Monthly. Edited by George
Bushe. New York. Two volumes. 1831-32. 8vo.

The United States Medical and Surgical Journal. Monthly. Edited by
an Association of Physicians. New York. Vols. I.— III. 1834-36. 8vo. After
No. 2, September, 1834, published at New York and Philadelphia.

The New York Journal of Medicine and Surgery. Quarterly. New York.
Vols. I.-IV. 1839-41. 8vo.

The New York Medical Gazette. Weekly. Published by U. Turner. New
York. Vols. I.-II. 1841-42. 8vo.

The New York Lancet. Weekly. Edited by J. A. Houston. New York.
Vols. I.-II., and Nos. 1-4, Vol. III. 1842-43. 8vo.

Albany Journal of Neurology. Monthly. By an Association of Physicians.
Albany. No. 1, Vol. I. July, 1843. 8vo.

The New York Journal of Medicine and the Collateral Sciences. Bi-
Monthly. Edited by S. Forry and others. New York. Thirty-four volumes.

1843- 60. 8vo. For continuation, see The American Medical Times. Vol. I.
Third Series. In 1856, the words "and the Collateral Sciences" dropped
from the title-page. The New York Medical Times merged in this journal.

The American Journal of Insanity. Quarterly. Edited by medical officer
of the New York State Lunatic Asylum, Utica, N. Y. Vols. I.-XXXIV.

1844- 78. 8vo. Current.

The New York Medical and Surgical Reporter. Bi-Weekly. Edited by
C. T. Collins. New York. Vol. I., 1845-46, and Nos. 1-18. Vol. II., 1847.
8vo.

The Buffalo Medical Journal. Monthly. Edited by A. Flint. Buffalo.
Fifteen volumes. 1845-60. 8vo. In July, 1860, merged in The American
Medical Monthly.

The Annalist. Bi-Weekly. Edited by W. C. Roberts and N. S. Davis. New
York. Three volumes. 1846-49. 8vo.

Wood's Addenda to the Medico-Chirurgical Review. Quarterly. New
York. Two volumes. 1847-49. 8vo. Also issued in somewhat different form
as Wood's Quarterly Retrospect of American and Foreign Practical Medi-
cine and Surgery.

The New York Register of Medicine and Pharmacy. Semi-Monthly.
Edited by C. D. Griswold. New York. Two volumes. 1850-51. 8vo.

The Northern Lancet and Gazette of Legal Medicine. Monthly. Edited
by F. J. D'Avignon and H. Nelson. Plattsburgh, N. Y. Vols. I.-XII. 1850-56.

MEDICAL JOURNALS

103

8vo. Vols. IV.-VL, title, Nelson's Northern Lancet, etc.; Vols. VII-XII.,
title. Nelson's American Lancet, etc.

The New York Medical Gazette and Journal of Health. Weekly and
Monthly. Edited by D. M. Reese. New York. Twelve volumes. 1850-61.
4to and 8vo. Vols. VI.-VIIL, title, The American Medical Gazette and
Journal of Health. Vols. IX.-XIL, title, The American Medical Gazette.

The New York Medical Times. Monthly. Edited by J. G. Adams and
others. New York. Vols. I.-V. 1851-56. 8vo. Merged in The New York
Journal of Medicine.

New Yorker Medicinische Monatsschrift. Edited by J. Herzka, E. Krako-
witzer, and W. Roth. New York. Jahrg. I. 1852-53. 8vo.

The American Medical Monthly. Conducted by Horace Green and
others. New York. Vols. I.-XVIII. 1854-62. 8vo.

The North American Medical Reporter. Quarterly. Edited by W. Elmer.
New York. Vol. I, 1858-59. 8vo.

The New York Medical Press. Weekly. Edited by J. L. Kiernan and
W. O. Meagher. New York. Vols. I.-III. 1859-60. Royal 8vo. Four pre-
liminary numbers were issued in 1858. In July, 1860, merged in The Ameri-
can Medical Times.

The Buffalo Medical and Surgical Journal and Reporter. Monthly.
Edited by J. F. Miner. Buffalo. Vols. I.-XVII. 1860-78. 8vo. Current. In
Vol. II., 1860, the words "and Reporter" dropped from title.

The American Medical Times. Weekly. Edited by Stephen Smith. New
York. Vols. I.-IX. 1860-64. 4to. Continuation of The New York Journal
of Medicine. In July, 1860, The New York Medical Press merged in this.

Summary of Medical Science. Semi-Annual. Edited by W. S. Wells. New
York. Part I. April, 1861. 8vo.

American Journal of Ophthalomology. Bi-Monthly. Edited by J. Hom-
berger. New York. Vol. I. 1862-63, and Nos. 1-2, Vol. II. 1864. 8vo. Vol. II.
became quarterly.

Nord Americanische Deutsch' medizinische Zeitschrift fur praktische
Heilkunde. Bi-Monthly. Edited by W. Meisburger. Buffalo. Nos. 1-3. Vol.
I. 1865. 8vo.

The New York Medical Journal. Monthly. Edited by W. A. Hammond,
E. S. Dunster, and others. New York. Twenty-eight volumes. 1865-78. 8vo.
Current.

The Medical Record. Semi-Monthly. Edited by G. F. Shrady. New York.
Fourteen volumes. 1866-78. 4to. Current. Vol. X., 1875, became weekly.

The Quarterly Journal of Psychological Medicine and Medical Juris-
prudence. Edited by W. A. Hammond. New York. Vols. I.-III. 1867-69.
8vo. Continued as the following.

The Journal of Psychological Medicine. Quarterly. New York. Vols.

104

JOHN SHAW BILLINGS

IV.-VI. 1870-72. 8vo. Continuation of the preceding. In July, 1874, the
publication was resumed as The Psychological and Medico-Legal Journal.

The Medical Gazette. Weekly. Edited by A. L. Carroll and others. New
York. Vols. I.-VL, and Nos. 1-6. Vol. III. 1867-71. 4to.

Revista medico quirurgica y dentistica de los Sres. Wilson y Gonzales.
Quarterly. Nueva York. Nos. 1-3. Tom I. 1868. 8vo.

The Physician and Pharmaceutist. Quarterly. Edited by G. J. Fisher and
others. New York. Vols. I.— III. 1868-71. 4to. Continued as the following.

The Physician and Pharmacist. Quarterly. New York. Vols. IV.-XI.
1871-78. 4to. Current. Continuation of the preceding.

The American Journal of Obstetrics and Diseases of Women and Chil-
dren. Quarterly. Edited by E. Noeggerath, B. F. Dawson, and others. New
York. Vols. I.-XI. 1868-78. 8vo. Current.

The Archives of Ophthalmology and Otology. Semi-Annual. Edited and
published simultaneously in English and German by H. Knapp, in New
York, and S. Moos, in Heidelberg. New York. Vols. I.-VII. 1869-78. 8vo.
Current. Vol. IV. became quarterly.

The American Journal of Syphilography and Dermatology. Quarterly.
Edited by M. H. Henry. New York. Vols. I.-V. 1870-74. 8vo.

The Medical World. Monthly. Edited by R. A. Vance. New York. One
Volume. 1871-72. 8vo.

Archives of Scientific and Practical Medicine and Surgery. Monthly.
Edited by C. E. Brown-Sequard and E. C. Seguin. New York. Nos. 1-5.
Vol. I. 1873. Royal 8vo.

The Sanitarian. Monthly. Edited by A. N. Bell and others. New York.
Vols. I.-VI. 1873-78. 8vo. Current.

Archives of Electrology and Neurology. Semi-Annual. Edited by G. M.
Beard. New York. Two volumes. 1874-75. 8vo.

The Psychological and Medico-Legal Journal. Monthly. Conducted by
W. A. Hammond and T. M. B. Cross. New York. New Series. Vols. I.— III.
1874-76. 8vo. For First Series see The Quarterly Journal of Psychological
Medicine. Vol. III. 1875-76, title, The American Psychological Journal.
Quarterly. Conducted by Allan McLane Hamilton and others.

Archives of Dermatology. Quarterly. Edited by L. D. Bulkley. New York.
Vols. I.-IV. 1874-78. 8vo. Current.

Proceedings of the Medical Society of the County of Kings. Monthly.
Conducted by the Council of the Society. Brooklyn. Vols. I.— III. 1876-78.
8vo. Current.

Archives of Clinical Surgery. Monthly. Edited by E. J. Bermingham.
New York. Vol. I. 1876-77. 8vo. In October, 1877, united with the following
forming the Hospital Gazette and Archives of Clinical Surgery.

The Hospital Gazette. Monthly. Edited by F. A. Lyons. New York. Nos.

MEDICAL JOURNALS

105

1-6. Vol. I. 1877. 4to. In October, 1877, united with the preceding, forming
the following.

The Hospital Gazette and Archives of Clinical Surgery. Semi-Monthly.
Edited by E. J. Bermingham and F. A. Lyons. New York. Four volumes.
Whole series. 1876-78. 8vo.

Revista mensual medico-quirurgica de Nueva York. A. de Tejada, Editor.
Nueva York. No. 1, Vol. I. October, 1878. 8vo. Current.

The New York Medical and Surgical Brief. Monthly. E. J. Fisk, Editor.
New York. No. 1, Vol. I. November, 1878. 8vo. Current.

North Carolina

The Medical Journal of North Carolina. Bi-Monthly. E. Warren, Editor.
Edenton and Raleigh. Four volumes. 1858-61. 8vo.

The North Carolina Medical Journal. Monthly. M. J. DeForrest and
Thomas F. Wood, Editors. Raleigh. Vols. I.-II. 1878. 8vo. Current. The
same was running title of preceding.

Ohio

The Western Quarterly Reporter of Medical, Surgical, and Natural
Science. Edited by J. D. Godman. Cincinnati. Vols. I.-II. 1822-23.

Ohio (The) Medical Repository of Original and Selected Essays and In-
telligence. Bi-Monthly. Edited by G. W. Wright and J. M. Mason. Cincin-
nati. Vol. I. 1826-27. Folio. Completed. Merged into the following in
April, 1827.

Western (The) Medical and Physical Journal. Original and eclectic.
Monthly. Edited by Daniel Drake and Guy W. Wright. Cincinnati. Vol. I.
1827-28. No. 1, Vol. II. May, 1828. 8vo. No. 1, Vol. II., believed to be the
last published. In April, 1828, the Western Journal of the Medical and
Physical Sciences was commenced by Daniel Drake, and was subsequently
represented and regarded as continuation of the above, the volume for
April, 1828, to March, 1829, being reckoned Vol. II. of the periodical.

Western (The) Journal of the Medical and Physical Sciences. Monthly.
Edited by Daniel Drake. Cincinnati. Vols. II.-XII. 1828-33. 8vo. No. 1,
Vol. XII. believed to be the last published. For Vol. I. see preceding.
In 1835, The Western Medical Gazette merged in this journal, January
1, 1840, revived and consolidated with the Louisville Journal of Medicine
and Surgery, forming The Western Journal of Medicine and Surgery.

Western (The) Medical Gazette. Semi-Monthly and Monthly. Edited by
Eberle and others. Vols. I.-II. 1832-35. 8vo. Completed. Suspended from
September 1, 1833, to February 1, 1834. In 1835 merged into the preceding.

Ohio (The) Medical Repository. Monthly. Edited by J. M. Mason. Cin-
cinnati, Nos. 1-5, Vol. I. 1835-36. 8vo.

106

JOHN SHAW BILLINGS

Western (The) Quarterly Journal of Practical Medicine. Edited by John
Eberle and others. No. 1, Vol. I. June, 1837. Cincinnati. 8vo. No more
published.

Western (The) Lancet. Devoted to medical and surgical science. Monthly.
Vols. I.-XVIII. Cincinnati and Lexington, 1842-1857. After April, 1843,
The Western and Surgical Medical Recorder merged in this journal. In
January, 1858, united with The Cincinnati Medical Observer, forming the
Cincinnati Lancet and Observer.

Ohio (The) Medical and Surgical Journal. Bi-Monthly. Edited by John
Butterfield. Columbus. Vols. I.-XVL 1848-64. 8vo. Completed.

American (The) Psychological Journal. Devoted chiefly to the elucida-
tion of mental pathology and the medical jurisprudence of insanity. Bi-
Monthly. Conducted by Edward Mead, Cincinnati. One volume. 1853. 8vo.
Completed. Prospectus for a new series to be published in Boston issued in
1874.

Medical (The) Counsellor. A weekly gazette of the medical and physical
sciences. R. Hills, Editor. Columbus, Ohio. Vols. I.— II. 1855-56. 8vo. Com-
pleted. The Ohio Medical Gazette was running title of this journal.

Cincinnati (The) Medical Observer. Edited by G. Mendenhall, J. A.
Murphy, and E. B. Stevens. Monthly. Vols. I.— II. 1856-57. 8vo. In Janu-
ary, 1858, united with The Western Lancet, forming the Cincinnati Lancet
and Observer.

Cincinnati (The) Medical News. Devoted to the dissemination of truth.
Edited by A. H. Baker. Monthly. Vol. I., Nos. 1 and 2. Vol. II., August 15,
1858, November 15, 1859. Folio. Continued as the Cincinnati Medical and
Surgical News.

Belmont (The) Medical Journal. A monthly periodical published under
the patronage of the Belmont Medical Society. Bridgeport, Ohio. Two
volumes. 1858-60. 12mo. Completed.

Cincinnati (The) Lancet and Observer. Edited by G. Mendenhall, J.
Murphy, and E. B. Stevens. Monthly. Vols. I.-XXI. 1858-78. 8vo. Com-
pleted. Formed by consolidation of the Cincinnati Medical Observer with
the Western Lancet. Consolidated with The Clinic, forming the Cin-
cinnati Lancet and Clinic.

Cleveland (The) Medical Gazette. A monthly journal for the advance-
ment and review of the Medical Sciences. Edited by G. C. E. Weber. Vols.
I. -III. 1859-61. 8vo. At end of Vol. I., consolidated with Cincinnati Lancet
and Observer, but each journal retained its own name, and they were
issued simultaneously.

Columbus (The) Review of Medicine and Surgery. Edited by W. L.
McMillen. Bi-Monthly. Nos. 1-5. Vol. I. August, 1860, to April, 1861. 8vo.
Completed.

MEDICAL JOURNALS

107

Cincinnati (The) Medical and Surgical News. Edited by A. H. Baker.
Monthly. Four volumes. 1860-63. 8vo. Completed. Continuation of the
Cincinnati Medical News.

Cincinnati (The) Journal of Medicine. Edited by G. C. Blackman, T.
Parvin, and R. Bartholow. Monthly. Vols. I.-IV. Cincinnati, Ohio, and
Indianapolis. 1866-69. 8vo. After No. 6 of Vol. II., title, The Western
Journal of Medicine. For continuation see The American Practitioner.

Cincinnati (The) Medical Repertory. Edited by J. A. Thacker. Monthly.
Vols. I.-IV. 1868-71. 8vo. For continuation see The Cincinnati Medical
News.

Clinic (The). Edited by J. T. Whittaker. Weekly. Cincinnati. Fourteen
volumes. 1871-78. 4to. Completed. Merged in Cincinnati Lancet and
Clinic, July 1, 1878.

Cincinnati (The) Medical News. Edited by J. A. Thacker and others.
Monthly. Vols. I -VII. 1872-78. 8vo. Continuation of The Cincinnati
Medical Repertory.

Ohio (The) Medical and Surgical Journal. Edited by J. H. Pooley. Bi-
Monthly. New Series. Columbus. Vols. I.-III. 1876-78. 8vo.

Ohio (The) Medical Recorder. Edited by J. W. Hamilton and J. F. Bald-
win. Monthly. Columbus. Vols. I.— II. 1876-78. 8vo.

Toledo Medical and Surgical Journal. Edited by J. Priest. Monthly. Vols.

I. -II. 1877-78. 8vo.

Cincinnati Lancet and Clinic. Weekly. J. C. Culbertson and J. G. Hynd-
man, Editors. No. 1. July 6, 1878. 8vo. Current. Formed by consolidation
of The Clinic with The Cincinnati Lancet and Observer.

The Obstetric Gazette. Monthly. E. B. Stevens, Editor. Vol. I. 1878.
Cincinnati. 8vo.

Oregon

The Oregon Medical and Surgical Reporter. Monthly. Edited by E. R.
Fiske and H. Carpenter. Salem. Two volumes. 8vo. Completed.

The Oregon Medical Journal. A quarterly journal of medicine and sur-
gery. Published by the Marion County Medical Society. Salem. Nos. 1-4.
Vol. I. 1876-77. 8vo.

Pennsylvania

The Philadelphia Medical and Physical Journal. Quarterly. Collected
and arranged by Benjamin Smith Barton. Vols. I— III. 1804-09. 8vo.

The Philadelphia Medical Museum. Quarterly. Conducted by John
Redman Coxe. Seven volumes. 1804-11. 8vo. Completed. A subdivision of
each number, entitled Medical and Philosophical Register, is, after Vol.

II, paged separately.

108

JOHN SHAW BILLINGS

The Eclectic Repertory and Analytical Review. Medical and philo-
sophical. Quarterly. Philadelphia. Vols. I-X. 1811-20. 8vo. For continua-
tion see Journal of Foreign Medicine.

The Journal of Foreign Medical Science and Literature. A continuation
of the Eclectic Repertory. Quarterly. Conducted by S. Emlen, Jr., and
William Price. Vols. I-IV. 1821-24. Philadelphia. 8vo.

The American Medical Recorder. Quarterly. Philadelphia. Vol. I-XV.
1818-29. 8vo. Completed. Merged in the American Journal of the Medical
Sciences, after No. 2, Vol. XV. Vols. VII-XII., title, The Medical Recorder,
etc.

The Philadelphia Journal of Medical and Physical Sciences. Quarterly.
Supported by an association of physicians, and edited by N. Chapman,
W. P. Dewees, J. D. Goodman, and Isaac Hays. Fourteen volumes. 1820-27.
8vo. Continued as the American Journal of the Medical Sciences.

The American Journal of the Medical Sciences. Quarterly. Edited by
Isaac Hays. Philadelphia. One hundred and two volumes. 1827-78. 8vo.

The AEsculapian Register. Weekly. Edited by several physicians. Phila-
delphia. Vol. I. June 17 to December 9, 1824. 8vo.

The Medical Review and Analectic Journal. Quarterly. Conducted by
John Eberle and George McClellan. Philadelphia. Three volumes. 1824-
26. 8vo. Completed. Vols. II— III., title, The American Medical Review and
Journal of Original and Selected Papers in Medicine and Surgery.

North American Medical and Surgical Journal. Quarterly. Conducted
by H. L. Hodge and others. Philadelphia. Vols. I-XII. 1826-31. 8vo. Com-
pleted.

The Philadelphia Monthly Journal of Medicine and Surgery. Edited by
N. R. Smith. Vol. I and Nos. 1-3, Vol. II. 1827-28. 8vo. After February,
1828, merged in The American Journal of the Medical Sciences.

The Monthly Journal of Foreign Medicine. Edited by S. Littell. Phila-
delphia. Vols. I-III. 1828-29. 8vo.

The Cholera Gazette. Weekly. Philadelphia. Nos. 1-16. Vol. I. July 11.
No. 21, 1832.

The American Lancet. Bi-Weekly. Edited by F. S. Beattie. Philadelphia.
Nos. 1-7. Vol. I. 1833.

American Cyclopedia of Practical Medicine and Surgery. A digest of
medical literature. Philadelphia. Two volumes. 1834-36. 8vo.

The American Medical Library and Intelligencer. A concentrated record
of medical science and literature. Edited by G. S. Pattison and R. Dungli-
son. Philadelphia. Specimen sheet November, 1836. Continued as The
American Medical Intelligencer.

The Eclectic Journal of Medicine. Monthly. Edited by John Bell. Phila-
delphia. Vols. I-IV. 1836-40. 8vo.

MEDICAL JOURNALS

109

The American Medical Intelligencer. A concentrated record of medical
science and literature. Semi-Monthly and Monthly. Edited by Robley
Dunglison. Philadelphia. Five volumes. 1837-42. 8vo. Continued as the
Medical News and Library.

Medical News and Library. Monthly. Philadelphia. Thirty-six volumes.
1843-78. 8vo. Current. A continuation of the preceding.

The Medical Examiner. Bi-Weekly and Monthly. Edited by J. B. Biddle,
M. Clymer, and W. W. Gerhard. Philadelphia. Vols. I-VII. 1838-44. Royal
8vo. Vols. I-XII. New Series. 1845-56. 8vo. In January, 1857, united with
the Louisville Review, forming the North American Medico-Chirurgical
Review.

The Bulletin of Medical Sciences. Monthly. Edited by John Bell. Phila-
delphia. Four volumes. 1843-46. 8vo. Completed.

Nordamerikanischer Monatsbericht fur Natur und Heilkunde. Phila-
delphia. Four volumes. 1850-52. 8vo.

The Philadelphia Medical and Surgical Journal. Semi-Monthly. Edited
by James Bryan. Vols. I-VI. 1853-58. 8vo.

The Medical Reporter. A quarterly journal, published under the direc-
tion of the Chester and Delaware County Medical Societies. West Chester,
Pennsylvania. Vols. I-III. 1853-56. 8vo.

The North American Medico-Chirurgical Review. Edited by S. D. Gross
and T. G. Richardson. Bi-Monthly. Philadelphia. Vols. I-V. 1857-61.
8vo. Completed, formed by consolidation of The Medical Examiner, Phila-
delphia, and the Louisville Review.

The Medical and Surgical Reporter. A weekly journal. Edited by S. W.
Butler and R. J. Levis. Philadelphia. Vols. I-XXXIX. 1858-78. 8vo.

Compendium of Medical Science. Half- Yearly. Edited by S. W. Butler,
D. G. Brinton, and G. H. Napheys. Philadelphia. Eleven volumes. 1868-78.
8vo.

The Photographic Review of Medicine and Surgery. A bi-monthly illus-
tration of interesting cases, accompanied by notes. Edited by F. F. Maury
and L. A. Duhring. Philadelphia. Two volumes. 1870-72. 8vo. Completed.

The Medical Times. A semi-monthly journal of medical and surgical
science. Edited by J. H. Hutchinson and J. Tyson. Philadelphia. Two vol-
umes. 1870-72. Royal 8vo. Continued as the following.

The Philadelphia Medical Times. A weekly journal of medical and
surgical science. Philadelphia. Vols. III-VII. 1872-1878. 8vo. Current. See
The Medical Times, for Vols. I-II. Vol. VI became bi-weekly.

The Medical Cosmos. A monthly abstract of medical science and art.
G. J. Zeigler, Editor. Vol. I. Nos. 1-5. Vol. II. Philadelphia. 1871-72. 8vo.

The Obstetrical Journal of Great Britain and Ireland: including mid-
wifery and the diseases of women and children. Monthly. Edited by J. H.

110

JOHN SHAW BILLINGS

Aveling and A. Wiltshire. With an American supplement, edited by Wm.
F. Jenks. Philadelphia. Vols. I-VI. 1873-78. 8vo.

The Monthly Abstract of Medical Science. Philadelphia. Vols. I-V. 1874-
78. 8vo.

South Carolina

Charleston Medical Register. Annual, by David Ramsay. 1802.

The Carolina Journal of Medicine, Science, and Agriculture. Quarterly.
Conducted by T. Y. Simons and W. Michel. Charleston. Vol. I. 1825. 8vo.

The Southern Journal of Medicine and Pharmacy. Bi-Monthly. Edited
by J. L. Smith and S. D. Sinkler. Charleston. Vols. I -II. 1846-47. 8vo. Con-
tinued as the following.

The Charleston Medical Journal and Review. Bi-Monthly. Edited by
P. C. Gaillard and H. W. De Saussure. Charleston. Vols. III.-XV. 1848-60.
8vo. Continuation of the preceding.

The Charleston Medical Journal and Review. Quarterly. New Series.
Edited by F. P. Porcher and R. A. Kinloch. Charleston. Vols. I.-IV. 1873-77.
8vo.

Tennessee

The East Tennessee Record of Medicine and Surgery. Quarterly. Edited
by F. A. Ramsey. Knoxville. 1 Vol. 1852-53. 8vo. After May, 1853, merged
in The Southern Journal of the Medical and Physical Sciences.

The Memphis Medical Recorder. Bi-Monthly. Edited by A. P. Merrill.
C. T. Quintard, and others. Memphis. Vols. I.-VL 1852-58. 8vo.

The Southern Journal of the Medical and Physical Sciences. Bi-Monthly.
Conducted by J. W. King and W. P. Jones. Nashville and Knoxville. Vols.
I -VI. 1853-57. 8vo. In 1853, The East Tennessee Record of Medicine and
Surgery merged in this Journal. In December No., 1857, The East Tennes-
see Medical Times announced as a continuation.

The East Tennessee Medical Times. Announced by R. O. Currey in
1857, to be issued monthly as a continuation of the Southern Journal of
the Medical and Physical Sciences, but never appeared, so far as I can
learn.

The Nashville Monthly Record of Medical and Physical Science. Edited
by D. F. Wright, R. O. Currey, and others. Vols. I.-IL, and Nos. 1, 2, Vol.
III. 1858-60. 8vo.

The Medical and Surgical Monthly. Edited by F. A. Ramsey. Memphis.
Nos. 1-6, Vol. I., 1866. 8vo.

The Nashville Journal of Medicine and Surgery. Bi-monthly and
monthly. Edited by W. K. Bowling, P. F. Eve, and others. Nashville. Vols.

MEDICAL JOURNALS

111

I. -XXI. 1851-61. New Series, Vols. I.-XXI. 1866-78. 8vo. Current. Vol.

II. , became monthly.

Texas

The Galveston Medical Journal. Monthly. Greensville Dowell, Editor.
Galveston. 5 vols. 1866-71. 8vo.

The Texas Medical Journal. Monthly. Edited by J. D. Rankin. Galves-
ton. Nos. 1-7, 10, Vol. I.; Nos. 2, 9, Vol. II.; Nos. 1, 2, 4, Vol. III.; Vols.
V.-VII. 1873-78. 8vo. Current. Vol. III., became quarterly.

Vermont

Vermont Medical Journal. Bi-Monthly. J. M. Currier, Editor. Burling-
ton. Nos. 1, 2, Vol. I. 1874. 8vo.

Virginia

The Stethoscope and Virginia Medical Gazette. Monthly. Edited by
T. P. Atkinson, R. W. Haxall, and others. Richmond. Vols. I.-V. 1851-55.
8vo. Vols. IV.-V.; title, The Stethoscope. In January, 1856, united with
The Virginia Medical and Surgical Journal, forming The Virginia Medi-
cal Journal.

The Monthly Stethoscope and Medical Reporter. Edited by G. A. Wilson
and R. A. Lewis. Richmond. Vol. I. Nos. 1-5, Vol. II. 1856-57. 8vo.

The Virginia Medical and Surgical Journal. Monthly. Edited by G. A.
Otis, and others. Richmond. Vols. I.-V. 1853-55. 8vo. Continued as the
following.

The Virginia Medical Journal. Monthly. Richmond. Vols. VI.-XIII.
1856-59. 8vo. Formed by the union of The Stethoscope with the Virginia
Medical and Surgical Journal. Continued as the following.

The Maryland and Virginia Medical Journal. Monthly. Richmond.
Vols. XIV.-XVI. 1860-61. 8vo. Continuation of the preceding.

The Confederate States Medical and Surgical Journal. Published under
the auspices of the Surgeon-General C. S. A. Monthly. Vol. I. Nos. 1, 2, of
Vol. II. January, 1864, to February, 1865. 4to.

The Richmond Medical Journal. Monthly. Edited by E. S. Gaillard and
W. S. McChesney. Richmond. Vols. I.-V. 1866-68. 8vo. Continued as The
Richmond and Louisville Medical Journal, q. v.

The Virginia Clinical Record. Monthly. Edited by J. S. Dorsey Cullen.
Richmond. Vols. I.-III. 1871-74. 8vo.

Virginia Medical Monthly. L. B. Edwards, Editor. Richmond. Vols. I.-V.
1874-78. 8vo. Current.

The Southern Clinic. Monthly. Edited by C. A. Bruce and J. R. Wheat.
Richmond. No. I., Vol. I., October, 1878. 8vo. Current.

112

JOHN SHAW BILLINGS

West Virginia

The West Virginia Medical Student. Monthly. J. E. Reeves, Editor.
Wheeling. Vol. I. 1875-76. 8vo.

The following table shows by countries the number of medical journals
and transactions received at the library of the surgeon-general's office and
regularly indexed. This list does not include pharmaceutical, chemical,
dental, veterinary, homoeopathic, hydropathic, eclectic, or popular jour-
nals.

Countries

United States

Mexico

South America

Argentine Confederation . . .

Brazil

Chile

Venezuela

Great Britain and Colonies. . .

France

Germany

Belgium

Netherlands

Spain

Portugal

Italy

Switzerland

Russia

Sweden and Norway

Denmark

Turkey

China

Poland

Total

There are now in existence the following medical journals of equal or
greater age than the Boston Medical and Surgical Journal, and a study of
the causes why these have survived so long would be a valuable contribu-
tion to the literature of journalism, but this study cannot be undertaken
here.

The Philadelphia Journal of the Medical and Physical Sciences. Phila-
delphia. 1820-27.

The American Journal of the Medical Sciences. Philadelphia. 1820-78.
Annales d'Hygiene publique et de M6decine legale. Paris. 1829-78.

MEDICAL JOURNALS

113

Annali universali di Medicina. Milano. 1817-78.
Archives generates de Medecine. Paris. 1823-78.
Bibliothek for Laeger. Kjobenhavn. 1821-78.

Bullettino delle Scienze mediche, pubblicato per cura della Societa
medico-chirurgica di Bologna. 1829-78.

Gazette de Sante, contenant les nouvelles Decouvertes sur les Moyens de
se bien porter, et de guerir quand on est malade. Paris. 1773-1829. Gazette
de Medecine de Paris; journal de Medecine et des Sciences accessoires.
Paris. 1773-1878.

The Edinburgh Medical and Surgical Journal. Edinburgh. 1805-55. The
Edinburgh Medical Journal; combining the Monthly Journal of Medicine
with the Edinburgh Medical and Surgical Journal. Edinburgh. 1805-78.

Gemeinsame deutsche Zeitschrift fur Geburtskunde. Weimar. 1826-32.
Neue Zeitschrift fur Geburtskunde. Berlin. 1834-52. Monatsschrift fur
Geburtskunde und Frauenkrankheiten. Berlin. 1853-69. Archiv fur Gynae-
kologie. Berlin. 1826-78.

Journal de Chimie m^dicale, de Pharmacie et de Toxicologic Paris.
1825-78.

Recueil periodique de la Society de Sante de Paris. (1797.) 2d ed. Re-
cueil periodique de la Societe de Medecine de Paris. 1797-1802. Journal
general de Mddecine, Chirurgie, et de Pharmacie, ou recueil periodique de
la Society de Medecine de Paris. 1802-30. Transactions medicales; Journal
de medecine pratique et de Litterature m^dicale, dans lequel sont publies
les Actes de la Societe de Medecine de Paris. 1830-33. Revue medicale
franchise et etrangere. Paris. 1797-1878.

Journal de Medecine, de Chirurgie, et de Pharmacie militaires. Paris.
1815-16. Recueil de Memoires de Medecine, de Chirurgie, et de Pharmacie
militaires, faisant suite au journal qui paraissait sous le meme titre. Paris.
1815-78.

The Lancet. A Journal of British and Foreign Medical and Chemical
Science, Criticism, Literature, and News. London. 1823-78.

The London Medical Gazette; a Weekly Journal of Medicine and the
Collateral Sciences. London. 1827-51. The Medical Times and Gazette. A
Journal of Medical Science, Literature, Criticism, and News. London.
1827-78.

Pamietnik Lekarski Warszawski. Warszawie. 1828-29. Pamietnik To-
warzystwa Lekarskiego Warszawskiego. Warszawa. 1828-78.

Voyenno-medtisinskii Journal, isdavayemwi Meditsinskim Departamen-
tom Voyennavo ministerstva. St. Petersburg. 1823-78.

Kritisches Repertorium fur die gesammte Heilkunde. Berlin. 1823-33.
Wochenschrift fiir die gesammte Heilkunde. Berlin. 1833-51. Vierteljahr-
sschrift fiir gerichtliche und offentliche Medicin. Berlin. 1852-71. Viertel-

114

JOHN SHAW BILLINGS

jahrsschrift fur gerichtliche Medicin und offentliches Sanitatswesen. Berlin.
1823-78.

Reil's Archiv fur die Physiologic Halle. 1796-1815. Deutsches Archiv
fur die Physiologic Halle. 1815-23. Archiv fur Anatomie und Physiologic
Leipzig. 1826-32. Archiv fur Anatomie, Physiologie, und Wissenschaftliche
Medicin. Leipzig. 1834-76. Archiv fur Anatomie und Physiologie. Leipzig.
1796-1878.

Who Founded the National
Medical Library?

Washington, February 3, 1880

To the Secretary of the Medical Society of the County of New York:

Dear Doctor — As my attention has several times been called to the com-
munication by Dr. Wm. A. Hammond relative to the library of this office,
read at the annual meeting of the Society, October 27, 1879, and more
especially to the report of this communication given on page 472 of the
New York medical record for November 15, 1879, with requests for ex-
planations, I deem it proper to make a statement on the matter to the
Society.

From the report in the record, some have inferred that I claim to have
been the founder of the National Medical Library, although the letter of
Dr. Hammond, as printed on page 40 of the minutes of that meeting,
makes it very plain that I have made no such claim.

The facts of the case are simply as follows:

For many years there was a small collection of medical books and journals
in the Surgeon-General's office at Washington, which collection was com-
menced by Surgeon-General Lovell prior to 1836.

At the commencement of the war this collection amounted to between
three and four hundred volumes.

Dr. Hammond entered on his duties as Surgeon-General April 28, 1862,
and left Washington August 30, 1863, after which date he was not on duty
in this office. During this interval three hundred and fifty-nine volumes
were purchased for the use of the office, the principal works being a set of
the "Annales d'Hygiene" and a set of the "Boston Medical and Surgical
Journal." During the years 1864 and 1865 about 1,000 volumes were added
to the library, mainly works selected by Drs. Woodward and Otis.

When the library came under my charge, in the fall of 1865, it con-
tained, as shown by a catalogue made at the time, about 1,800 volumes. At
this date it contains about 50,000 volumes and 60,000 pamphlets.

Very respectfully and truly yours,
John S. Billings
Surgeon U. S. Army

Medical Record (NY) 17: 298-9 (1880).

115

Our Medical Literature

When I was surprised by the honour of an invitation to address this
Congress, my first thought was that it must be declined, for the simple, but
sufficient reason that I had nothing to say that would be worth occupying
the time of such an assemblage as it was evident this would be. But while
thinking over the matter, and looking absent-mindedly at a shelf of cata-
logues and a pile of new books and journals awaiting examination, it oc-
curred to me that perhaps some facts connected with our medical literature,
past and present, from the point of view of the reader, librarian, and
bibliographer, rather than from that of the writer or practitioner, might
be of sufficient interest to you to warrant an attempt to present them; and,
the wish being probably father to the thought, I decided to make the trial.

When I say "Our Medical Literature," it is not with reference to that
of any particular country or nation, but to that which is the common
property of the educated physicians of the world as represented here to-day
— the literature which forms the intra- and international bond of the medi-
cal profession of all civilized countries; and by virtue of which we, who
have come here from the far West and the farther East, do not now meet,
for the first time, as strangers, but as friends, having common interests, and
though of many nations, a common language, and whose thoughts are
perhaps better known to each other than to some of our nearest neighbours.

It is usual to estimate that about one-thirtieth part of the whole mass of
the world's literature belongs to medicine and its allied sciences. This
corresponds very well to the results obtained from an examination of
bibliographies, and catalogues of the principal medical libraries. It ap-
pears from this that our medical literature now forms a little over 120,000
volumes properly so called, and about twice that number of pamphlets,
and that this accumulation is now increasing at the rate of about 1,500 vol-
umes and 2,500 pamphlets yearly.

Let us consider the character of this annual growth somewhat in detail,
first giving some figures as the numbers of those who are producing it.

There are at the present time scattered over the earth about 180,000
medical men, who, by a liberal construction of the phrase, may be said
to be educated; that is, who have some kind of a diploma; and for whose
edification this current medical literature is produced. Of this number
about 11,600 are producers of, or contributors to, this literature, being

Delivered in London, August 5, 1881, before the International Medical Congress.
Transactions of the International Medical Congress (7'*, London, 1881). v. 1, pp. 54-70.

116

OUR MEDICAL LITERATURE

117

divided as follows: United States, 2,800; France and her Colonies, 2,600;
the German Empire and Austro-Hungary, 2,300; Great Britain and her
Colonies, 2,000; Italy, 600; Spain, 300; all others, 1,000. These figures
should be considered in connection with the number of physicians in each
country; but this I can only give approximately, as follows: United States
65,000; Great Britain and her Colonies, 35,000; Germany and Austro-
Hungary, 32,000; France and her Colonies, 26,000; Italy, 10,000; Spain,
5,000; all others, 17,000.

It will be seen from these figures that the number of Physicians who are
writers, is proportionately greatest in France and least in the United
States. As regards France, this is largely due to the requirement of a printed
thesis for graduation, which of itself adds between six and seven hundred
annually to the number of writers.

Excluding popular medicine, pathies, pharmacy and dentistry, all of
which were included in the figures for the annual product just given, we
find that the contributions to medicine, properly so called, form a little
over 1000 volumes and 1600 pamphlets yearly.

For 1879, Rupprecht's Bibliotheca gives as the total number of new
medical books, excluding pamphlets, periodicals and transactions, 419;
divided as follows, viz.: France, 187; Germany, 110; England, 43; Italy,
32; United States, 21; all others, 26. These figures are, however, too small,
and especially so as regards Great Britain and the United States. The Index
Medicus for the same year shows by analysis that the total number of
medical books and pamphlets, excluding periodicals and transactions was
1643; divided as follows: France, 541; Germany, 364; United States, 310;
Great Britain, 182; all others, 246. This does not include the inaugural
theses, of which 693 were published in France alone.

The special characteristics of the literature of the present day are largely
due to journals and transactions, and this is particularly true in medicine.
Our periodicals contain the most recent observations, the most original
matter, and are the truest representations of the living thought of the
day, and of the tastes and wants of the great mass of the medical profession,
a large part of whom, in fact, read very little else. They form about one-
half of the current medical literature, and in the year 1879 amounted to
655 volumes, of which the United States produced 156; Germany, 129;
France, 122; Great Britain, 54; Italy, 65; and Spain, 24. This is exclusive
of journals of pharmacy, dentistry, Sec, and of journals devoted to medical
sects and isms. These are given in an appended table from which it ap-
pears that the total number of volumes of medical journals and transactions
of all kinds was for the year 1879,-850 and for 1880,-864. The figures
for 1880 are too small, but the real increase is slight. During the year 1879,
the total number of original articles in medical journals and transactions

JOHN SHAW BILLINGS

Total

1880

355
151

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Gynaecology and Obstetrics

OUR MEDICAL LITERATURE

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JOHN SHAW BILLINGS

which were thought worth noting for the Index Medicus was a little over
20,000. Of these there appeared in American periodicals 4781, in French,
4608; in German, 4027; in English, 3592; in Italian, 1210; in Spanish, 703;
in all others, 1248. The figures for 1880 are about the same. It will be seen
that at present more of this class of literature appears in the English lan-
guage than in any other, and that the number of journal contributions is
greatest in the United States. The actual bulk of periodical literature is,
however, greatest in Germany, owing to the greater average length of the
articles. With regard to the mode of publication, I will only say that in
all countries except Spain, the greater number of medical periodicals are
monthly, while in Spain they are semi-monthly. It is this periodical litera-
ture which, more than anything else, makes medicine cosmopolitan, and
although as regards new discoveries or methods of treatment, it is still
somewhat farther from London or Berlin or Paris to New York, than it is
from New York to either of these places, the discrepancy is gradually be-
coming less.

Many of the medical journals are very short lived, but the total number
is increasing. In 1879, 23 such journals ceased, but 60 new ones appeared,
and in 1880 there were 24 deaths and 78 births in this department of litera-
ture. Over one-third of this fluctuation occurs in the United States alone,
France being next in the scale, Spain third and Italy fourth, while Great
Britain is the most stable of all.

This merely quantitative classification gives of course no idea as to the
character, and very little as to the value of the product. Let us now consider
it by subjects. During 1879 there were published 167 books and pamphlets
and 1543 articles relating to anatomy, physiology and pathology — that is,
to the biological or scientific side of medicine. Dividing this again by na-
tions, we find that Germany produced a majority of the whole, France be-
ing second. The proportionate production by nations of this class of
literature is perhaps better shown by an analysis of the bibliography of
physiological literature for the year 1879, as published by the Journal of
Physiology. This shows 59 treatises and 500 articles in German, 17 treatises
and 227 articles in French, 5 treatises and 77 articles from Great Britain,
8 treatises and 41 articles from Italy, and 2 treatises and 24 articles from the
United States. The number of authors for this product was, German, 393,
French, 119, English, 59, Italian, 39, United States, 19, all others, 41. For
the year 1880 the same journal reports 62 treatises and 452 articles from
Germany, 23 treatises and 216 articles from France, 12 treatises and 76
articles from Great Britain, 4 treatises and 51 articles from Italy, 6 treatises
and 25 articles from the United States, and 10 treatises and 31 articles from
all other countries.1

1 The difference between these figures and those of the Index Medicus, is due, on the

OUR MEDICAL LITERATURE

121

When we turn to the literature of the art, or practical side of the pro-
fession the figures are decidedly different. We find over 1200 treatises and
18,000 journal articles which come under this head, and the order of
precedence of countries as to quantity is: France, United States, Germany,
Great Britain, Italy and Spain. The appended tables give still further
subdivisions, showing by nations the number of works and journal articles
upon the practice of medicine, surgery, obstetrics, hygiene, etc., for the
years 1879 and 1880, and some of the figures will be found interesting. A
marked increase has occurred in the literature of hygiene during the last
two years, and this especially in England, France, Germany and the United
States. The literature of diseases of the nervous system, of ophthalmology,
otology, dermatology, and gynaecology, is also increasing more rapidly than
that of the more general branches.

It would of course be extremely unscientific to use these figures as if
they represented positively ascertained and comparable facts, the accuracy
of which, as well as of the classification, could be verified. They represent
merely the opinions of an individual — first as to whether each treatise or
pamphlet included in these statistics was worth noting, and second as
how it should be classed. Had everything been indexed the figures, for
journal articles at least, might have been nearly doubled; while if the se-
lection had been made by a more severe critic they might have been re-
duced one-half.

If I had to do the work again I should not obtain the same results. The
prevailing error is that, as regards journal articles, the figures are too large,
for some of those included are of so little value or interest that they are, I
fear, never read by more than two persons.

Be that as it may, I think we can take them as indicating certain differ-
ences in the direction of work of the medical authors of the great civilized
nations of the earth; but they must be considered as approximations only;
and the statistical axiom must be remembered that the results obtained
from a large number of facts are applicable to an aggregate of similar facts
but not to single cases. There will be a certain number of medical books
and papers printed next year, just as there will be a certain number of
children born; — and as we can within certain limits predict the number
of these births and the proportion of the sexes, or even of monsters; — so
we can within certain limits predict the amount and character of literature
that is yet to come, the ideas that are yet unborn. The differences are due
to race, political organization, and density of population. As Dr. Chadwick

one hand, to the fact that the Journal of Physiology includes articles which are placed
under other headings in the Index Medicus, and on the other hand, to the fact that the
Journal has a different standard of excellence from that of the Index, rejecting many
articles which the latter must accept as original.

122

JOHN SHAW BILLINGS

Total

1880

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OUR MEDICAL LITERATURE

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124

JOHN SHAW BILLINGS

has pointed out, in speaking of the statistics of obstetric literature, one of
the chief causes of the multiplication of medical societies is geographical.
"In England it is possible for those who are specially interested in gynae-
cology and obstetrics to attend the meetings of the Obstetrical Society of
London, whereas in America the distances are so great that this is im-
possible." Speaking broadly we may say that at present Germany leads
in scientific medicine both in quantity and quality of product, and that
the rising generation of physicians are learning German physiology. But
the seed has gone abroad and scientific work is receiving more and more
appreciation everywhere.

Seven years ago Professor Huxley declared that if a student in his own
branch showed power and originality he dared not advise him to adopt a
scientific career, for he could not give him the assurance that any amount
of proficiency in the biological sciences would be convertible into the most
modest bread and cheese. To-day I think he might be bolder, for such a
fear would hardly be justifiable; at all events, in America; where such a
man as is referred to could almost certainly find a place, bearing in mind
the Professor's remark that it is no impediment to an original investigator
to have to devote a moderate portion of his time to giving instruction
either in the laboratory or in the lecture room.

Within the last ten years the literature of France, Germany, Great
Britain, and the United States has contained much with regard to medical
education and the means for its improvement. In all these countries there
is more or less dissatisfaction with the existing condition of things, although
there is no general agreement as to the remedy. Solomon's question,
"Wherefore is there a price in the hands of a fool to get wisdom, seeing he
hath no heart to it?" is now easily answered, for even a fool knows that he
must have the semblance of wisdom, and a diploma to imply it, if he is to
succeed in the practice of medicine; but to ensure the value of a diploma
as a proof of education is the difficulty.

This evidence of discontent and tendency to change is a good sign. In
these matters stillness means sleep or death — and the fact that a stream is
continually changing its bed shows that its course lies through fertile
alluvium and not through sterile lava or granite.

I have said that as regards scientific medicine we are at present going
to school to Germany. This, however, is not the case with regard to thera-
peutics either external or internal, — in regard to which I presume that the
physicians of each nation are satisfied as to their own pre-eminence. At all
events it is true that, for the treatment of the common diseases, a physician
can obtain his most valuable instruction in his own country; among those
whom he is to treat. Just as each individual is in some respects peculiar and
unique, so that even the arrangement of the minute ridges and furrows at

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the end of his forefinger differs from that of all other forefingers, and is
sufficient to identify him; and as the members of certain families require
special care to guard against haemorrhage, or insanity, or phthisis; so it is
with nations and races. The experienced military surgeon knows this well,
and in the United States, which is now the great mixing ground, illustra-
tions of race peculiarities are familiar to every practitioner.

Neither the tendency nor the true value of this current medical literature
can be properly estimated by attending to it alone. It is a part of the
thought of the age — of that wonderful kaleidoscopic pattern which is un-
rolling before us, and must be judged in connection with it. From several
sources of high authority there have come of late years warnings and la-
ments that science is becoming too utilitarian. For example, Prof. Du
Bois-Reymond in his address upon civilization and science, says that that
side of science which is connected with the useful arts is steadily becoming
more prominent, each generation being more and more bent on material
interests. "Amid the unrest which possesses the civilized world men's minds
live as it were from hand to mouth. * * * And if industry receives its im-
pulse from science it also has a tendency to destroy science. In short,
idealism is succumbing in the struggle with realism and the kingdom of
material interests is coming." Having laid down this rather pessimistic
platform, he goes on to state that this is especially the case in America which
is the principal home of utilitarianism, and that it has become the custom
to characterize as "Americanization" the dreaded permeation of European
civilization by realism. If this characterization be correct it would seem that
Europe is pretty thoroughly Americanized as regards attention to material
interests and appreciation of practical results. But the truth of the picture
seems to me doubtful. Science is becoming popular, even fashionable, and
some of its would be votaries rival the devotees of modern iEstheticism in
their dislike and fear of the sunlight of comprehensibility and common
sense. The languid scientific swell who thinks it bad style to be practical,
who takes no interest in any thing but pure science, and makes it a point to
refrain from any investigations which might lead to useful results lest he
might be confounded with mere "practical men" or "inventors," exists
and has his admirers. We have such in medicine, and their number will
increase.

The separation of biological study from practical medicine, which has
of late years become quite marked in the literature of the subject, has its
advantages and disadvantages. Thus far the former have far outweighed
the latter, and both the science and the art of medicine have been promoted
thereby. But are not the physiologists, or as I believe they prefer to be
called, the biologists, separating themselves too completely from medicine
for the best interests of their own science, in that they are neglecting hu-

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man pathology? In our hospital wards and among our patients, nature is
continually performing experiments which the most dexterous operator
cannot copy in the laboratory — she is, as Professor Foster says, "a relentless
and untrammelled vivisector, and there is no secret of the living frame
which she has not, or will not, at some time or place, lay bare in misery and
pain."

Now while it is true that Professor Foster, in his address before the
British Medical Association last year, (which address is the clearest ex-
position of the aims of the physiology of the present day that I have seen)
insists upon the fact that all distinctions between physiology and pathology
are fictitious, and declares that attempts to divide them are like attempts
to divide meteorology into a science of good and a science of bad weather,
his conclusion that the pathologist should be trained in methods of physio-
logical investigation seems to me to be only a part of the truth. The tacit
assumption is that all, or at least the most important, phenomena of hu-
man disease may be reproduced in the physiological laboratory. If this
were only true, what a tremendous stride would have been taken towards
making medicine a science. Unfortunately it is not so. Many of the most
interesting of these phenomena — the most interesting because as yet the
most unexplainable — can only be observed in the sick man himself. Nor
have the physiologists as yet made much use of that field which ought to be
specially inviting to them — namely: comparative pathology; although the
literature of the present time already indicates that a change has begun in
this respect.

While it is true that to the graduate of thirty years ago much of the
physiological literature of the present day is in an unknown tongue, it is
also true that the physiologist of the present, who confines himself to lab-
oratory work, will find himself distanced by the man who keeps his clinical
and pathological studies and his experimental work well abreast.

The increase in both the amount and value of the literature of the sev-
eral specialities in medicine is readily seen by a comparison of recent cata-
logues and bibliographies with those of twenty or thirty years ago, and this
increase still continues at a greater rate than prevails in the more general
branches. There are great differences of opinion as to the relative value of
this increase and as to its future effect upon the profession, but there can be
no doubt as to the fact. There must be specialities and specialists in medi-
cine, and the results will be both good and evil; but the evils fall largely

upon those specialists who have an insufficient general education, who

attempt to construct the pyramid of their knowledge with the small end
as a foundation. It has been said by Dr. Hodgen that "in medicine a spe-
cialist should be a skilled physician and something more, but that he is
often something else — and something less." There is truth in this: truth

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which the young man will do well to consider with care before he begins
to specialize his studies; but on the other hand it is also true that the great
majority of men must limit their field of work very much and very clearly
if they hope to achieve success. The tool must have an edge if it is to cut.
It is by the labour of specialists that many of the new channels for thought
and research have been opened, and if the flood has sometimes seemed to
spread too far, and to lose itself in shallow and sandy places, it has never-
theless tended to fertilize them in the end.

The specialists are not only making the principal advances in science
but they are furnishing both strong incentives and valuable assistance to-
wards the collection and preservation of medical literature and the forma-
tion of large public libraries.

Burton declares that a great library cannot be improvised, not even if
one had the national debt to do it with — thinks that 20,000 volumes is
about the limit of what a miscellaneous collection can bring together, and
refers especially to the difficulty in creating large public libraries in Amer-
ica. My experience would show that these statements do not apply to medi-
cal books. Of these the folios and quartos of three and four hundred years
ago seem to have had great capacity for resistance to ordinary destructive
forces. Perhaps much of this is due to the fact that they are not usually in-
jured by too much handling or perusal. True, they are gradually becoming
rarer, but at the same time by means of properly organized libraries they are
becoming more accessible to all who wish to really use them, and not
merely to collect and hide them away. They drift about like the sea weed,
but the survivors are gradually finding secure and permanent resting-places
in the score of great collections of such literature which the world now
possesses. At present the currents of trade are carrying them in relatively
large numbers to the United States, where medical collectors and specialists
are among the best customers of the antiquarian booksellers of Europe. I
could name a dozen American physicians who have given to European
agents almost unlimited orders for books relating to their several speciali-
ties, and upon their shelves may be found books of the 15th and 16th cen-
turies, which may be properly marked as "rarissime."

Not that the rarest books are by any means the oldest. The collector who
seeks to ornament his shelves with the "Rose of John of Gaddesden," or
the "Lily of Bernard de Gordon," the first folios of "Avicenna" or "Celsus,"
or almost any of the eight hundred medical incunabula? described by Hain,
will probably succeed in his quest quite as soon as the one who has set his
heart on the first editions of Harvey or Jenner, the American tracts on
inoculation for small-pox, or complete sets of many of the journals and
transactions of the present century.

Whatever may be the chosen line of the book collector, he is the special

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helper of the public library, and this whether he intend it or not. In most
cases his treasures pass through the auction room, and sooner or later the
librarian, who can afford to wait, will secure them from further travel.
Thanks to the labours of such collectors, I think it is safe to say, — what
certainly would not have been true twenty years ago, — that if the entire
medical literature of the world with the exception of that which is col-
lected in the United States, were to be now destroyed, nearly all of it that
is valuable could be reproduced without difficulty.

What is to be the result of this steadily increasing production of books?
What will the libraries and catalogues and bibliographies of a thousand,
or even of a hundred years hence be like, if we are thus to go on in the ratio
of geometric progression, which has governed the press for the last few
decades? The mathematical formula which would express this, based on
the data of the past century, gives an absurd and impossible conclusion,
for it shows that if we go on as we have been going there is coming a time
when our libraries will become large cities, and when it will require the
services of every one in the world, not engaged in writing, to catalogue and
care for the annual product. The truth is, however, that the ratio has
changed, and that the rate of increase is becoming smaller. In western
Europe, which is now the great centre of literary production, it does not
seem probable that the number of writers or readers will materially increase
in the future, and it is in America, Russia, and southern Asia, that the
greatest difference will be found between the present amount of annual
literary product and that of a century hence.

The analogies between the mental and physical development of an in-
dividual, and of a nation or society, have been often set forth and com-
mented on, but there is one point where the analogy fails as regards the
products of mental activity, — and that is that as yet we have devised no
process for getting rid of the exuviae. Growth and development in the
physical world imply the changes of death as well as of life — that with the
increase of the living tissues there shall also be the excretion and destruc-
tion of dead, outgrown and useless matters which have had their day and
served their purpose. But liter a scrip ta manet. There is a vast amount of
this effete and worthless material in the literature of medicine, and it is in-
creasing rapidly. Our literature is in fact something like the inheritance of
the golden dustman, but with this important difference, viz: that when the
children raked a few shells or bits of bone from the dust-man's heap, — and,
after stringing them together and playing with them a little while, threw
them back, — they did not thereby add to the bulk of the pile, — whereas
our preparers of compilations and compendiums, big and little, acknowl-
edged or not, are continually increasing the collection, and for the most
part with material which has been characterized as "superlatively middling,

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the quintessential extract of mediocrity." A large medical library is in itself
discouraging to many inquirers, and I have become quite familiar with the
peculiar expression of mingled surprise, awe and despair which is apt to
steal over the face of one not accustomed to such work when he first finds
himself fairly in the presence of the mass of material which he wishes to
examine for the purpose of completing his ideal bibliography of, — let us
say epilepsy, — or excisions, — or the functions of the liver.

Let such enquirers, as well as those who regret that they have no access
to large libraries, and must therefore rely on the common text books and
current periodicals for bibliography, console themselves with the reflection
that much the larger part of all of our literature which has any practical
value belongs to the present century, and indeed will be found in the pub-
lications of the last 20 years.

There are a few books written prior to 1800 which every well educated
medical man should, — I will not say read but — dip into, such as some of
the works of Hippocrates and Galen, of Harvey and Hunter, of Morgagni
and Sydenham — but this is to be done to learn their methods and style
rather than their facts or theories, and by the great majority of physicians
it can be done with much more profit in modern translations than in the
originals. The really valuable part of the observations of these old masters
has long ago become a part of the common stock, and the results are to be
found in every text book.

If, perchance, among the dusty folios there are stray golden grains yet
ungleaned, remember that just in front are whole fields waiting the reaper.
There is not, and has not been any lack of men who have the taste and
time to search the records of the past, and the man who has opportunities
to make experiments or observations for himself wastes his time, to a cer-
tain extent, if he tries to do bibliographical work so long as he can get it
done for him. He wishes to know whether this problem has been attacked
before, and with what result — whether there are accounts of any other
cases like the one he has in hand. In ninety-nine instances out of a hundred
if the answer to these questions is not given in the current text books or
monographs it is not worth prolonged search by the original investigator.
Yet he should know how to make this search, if only to enable him to direct
others, and it is for this reason that a little acquaintance with bibliographi-
cal methods of work ought to be obtained by the student.

When a physician has observed or (thinks he has observed), a fact, or has
evolved from his inner consciousness a theory which he wishes to examine
by the light of medical literature, he is often very much at a loss to know
how to begin, even when he has a large library accessible for the purpose.

The information he desires may be in the volume next his hand, but how
is he to know that? And even when the usual subject-catalogue is placed

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before him he finds it very difficult to use it, especially when, as is often the
case, he has by no means a well defined idea as to what it is he wishes to
look for. Upon the title page of the Washington City Directory is printed
the following aphorism, "To find a name you must know how to spell it."
This has a very extensive application in medical bibliography. To find ac-
counts of cases similar to your own rare case you must know what your
own case is.

To return to the Subject-Catalogue. If it is a classed catalogue, a cata-
logue raisonn£e — it will often seem to be a very blind guide to one who is
not familiar with the classification and nomenclature adopted by the com-
piler. And certainly some of these classifications are very curious — remind-
ing one of Heine's division of ideas into reasonable ideas, unreasonable
ideas, and ideas covered with green leather. But if the enquirer has mas-
tered the arrangement of the catalogue it is two to one that it will not help
him. It is a catalogue of the titles of books, but very often the title of a book
gives very little information as to its contents, if indeed it is not actually
misleading. Now suppose the particular case he has in hand is one of a
new-born infant having one leg much larger and longer than the other.
He will find no book title relating to this. There may be a book in the
library on diseases of the lymphatics which contains just what he wants, but
unless he knows that his case is one affecting the lymphatics he will hardly
get the clue. There may also be in the library twenty papers, in as many
different volumes of journals and transactions, the titles of which show
that they probably relate to similar cases, but the titles of such papers do
not appear in the catalogue.

It should also be observed that Subject-Catalogues may easily be put to
improper uses, or thought to give more information than they really do.
They are not bibliographies, but mechanical aids in bibliographical work.

You will, perhaps, pardon me for taking as an illustration the Index
Catalogue of the library of the Surgeon-General's office in Washington,
as being one with which I am familiar, and which I can venture to comment
on without risk of its being thought that I wish to depreciate its value.
Taking any given subject in medicine, it is possible for a fairly educated
physician to obtain from this catalogue a large proportion of all the refer-
ences which have any special value, and by so doing to save a vast amount
of time and labour. On the other hand, he will find when he comes to ex-
amine the books and articles referred to, that at least one-half of them are
of no value so long as the other half are accessible, seeing that they are
dilutions and dilatations, re-hashes and summaries of the really original
papers. If the seeker is in the library itself, this does not cause a great
waste of time, as he can rapidly examine and lay aside those that do not
serve his purpose. But if he is using this catalogue in another library — say

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131

here in London, the case is different. It is highly improbable that he will
find in any other collection all the books referred to, and then comes the
annoyance of the doubt as to whether he may not be missing some very
valuable paper. How is he to know whether or not Smith, in his pamphlet
on the functions of the pneumogastric, has anticipated his own theory of
its relations to enlarged tonsils? And in all such cases "omne ignotum est
pro magnifico." In a bibliography of the subject, prepared from the same
material as the catalogue, he would either find no mention of Smith's
paper, or, better still, a note that his paper is merely an abstract, or com-
pilation. The fact that he does not find Smith's book in the London
library, nor any allusion to it in the best works on the subject, ought to
induce him to ignore it altogether.

In proportion to the energy of the young writer, and his determination
to not only note everything that has been written about his subject, but to
carry out the golden rule of verifying all his references, he is apt to be led off
from his direct research into the many attractive by-paths of quaint and
curious speculation which he will find branching off on every side, and this
danger must be guarded against, or he will find that he is wasting his time
and energy in turning over chaff which has long ago been pretty thoroughly
threshed and winnowed.

It is, however, no part of my present purpose to set forth the methods and
principles of bibliography; it is sufficient to point out their importance,
and to call attention to the point that a knowledge of how and where to
find the record of a fact is often of more practical use than a knowledge of
the fact itself, just as we value an encyclopaedia for occasional reference,
and not for the purpose of reading through from cover to cover.

Instruction in the history and literature of medicine forms no part of the
course of medical education in English and American schools; nor should
I be disposed to recommend its introduction into the curriculum if it were
to be based on French and German models but it does seem possible to take
a step in this direction which would be of great value, not only as a means
of general culture, as teaching students how to think, but from a purely
practical point of view, in teaching them how to use the implements of
their profession to the best advantage — for books are properly compared
to tools of which the index is the handle. Such instruction should be given
in a library, just as chemistry should be taught in a laboratory. The way to
learn history and bibliography is to make them — the best work of the in-
structor is to show his students how to make them.

In the absence of some instruction of this kind the student is liable to
waste much time in bibliographical research. There has been much more
done in this direction than many writers seem to suppose, and there are not
many subjects in medicine which have not been treated from this point of

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view. Of course all is not bibliography which pretends to be such. Very
many of the exhaustive and exhausting lists of references which are now so
common in medical journal articles have been taken largely at second-
hand, and thereby originate or perpetuate errors. It is well to avoid false
pride in this matter. To overlook a reference is by no means discreditable,
— but a wrong reference, or an unwitting reference to the same thing twice,
gives a strong presumption of carelessness and second-hand work. Journal
articles, however, and especially reports of cases, undergo strange trans-
mogrifications sometimes, and I have watched this with interest in the case
of a French or German paper, translated and condensed in the London
Record, then appearing in abstract under the name of the translator in a
leading journal, then translated again, with a few new circumstances, in a
continental periodical, and finally perhaps reversed and appearing as an
original contribution in the pages of the "Little Peddlington Medical Uni-
verse."

In this connection it is well to remember that a mere accumulation of
observations, no matter how great the number, does not constitute science,
especially if these observations have been recorded under the influence of
the same theories and in essentially similar conditions.

Science seeks the law which governs or explains the phenomena, and
when this is found the records of isolated instances of its action usually be-
come of small importance so far as that law is concerned. We care little
now for the records of the chemical experiments of a century ago, and the
many detailed accounts of the earlier cases of the use of ether or chloro-
form are of so little interest at the present time that it is not worth while
to refer to them in a bibliography of the subject. And although much has
been done towards classifying and indexing our medical records (more in
fact than most physicians suppose) still, as Helmholtz points out, such
knowledge as this hardly deserves the name of science, since it neither
enables us to see the complete connection nor to predict the result under
new conditions yet untried.

Do I seem to depreciate the value of the thoughts which our masters have
left us, and which have furnished the foundations on which we build? —
or to undervalue the importance of the great medical libraries in which are
stored these thoughts? — or to speak slightly of the utility of the catalogues,
and indexes, and bibliographies, without which such libraries are trackless
and howling wildernesses? If so, I have said what I did not mean to say.
The subject has been considered from the point of view of what used to be
called the division of labour, but which now I suppose should be called
evolution and differentiation, and this has been done because life is short
and the art is long, — with fair prospect of becoming longer. It is surely
unnecessary for me to enter upon any panegyric of books or libraries. As

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133

Dr. Holmes says: "It is not necessary to maintain the direct practical
utility of all kinds of learning. Our shelves contain many books which only
a certain class of medical scholars will be likely to consult. There is a
dead medical literature, and there is a live one. The dead is not all ancient,
the live is not all modern. There is none, modern or ancient, which, if it
has no living value for the student, will not teach him something by its
autopsy. But it is with the live literature of his profession that the medical
practitioner is first of all concerned."

In medicine, as in social science, we must depend for many facts upon
the observation of conditions which occur very rarely, and which cannot
be repeated at pleasure. I have already alluded to the importance of Na-
ture's vivisections to the physiologist, and a record of a case written a cen-
tury ago may be just the link that is needed to correlate the results of his
experiments of yesterday with existing theories. The case, which at first
seems unique and inexplicable, both receives and furnishes light when com-
pared with ancient records.

A science of medicine, like other sciences, must depend upon the classi-
fication of facts, upon the comparison of cases alike in many respects, but
differing somewhat either in their phenomena or in the environment. The
great obstacle to the development of a science of medicine is the difficulty
in ascertaining what cases are sufficiently similar to be comparable — which
difficulty is in its turn largely due to insufficient and erroneous records of
the phenomena observed. This defect in the records is largely due — first,
to ignorance on the part of observers; second, to the want of proper means
for precisely recording the phenomena; and third, to the confused and
faulty condition of our nomeclature and nosological classification.

Let us consider each of these points briefly. Very, very few are the men
who can, by and for themselves, see and describe the things that are before
them. Just as it took thousands of years to produce a man who could see
what now any one can see when shown him, that the star Alpha in Capri-
corn is really two separate stars, so we had to wait long before the man came
who could see the difference between measles and scarlatina, and still
longer for the one who could distinguish between typhus and typhoid.
Said Plato, "He shall be as a god to me, who can rightly divide and define."
Men who have this faculty — the "Blick" of the Germans — we cannot pro-
duce directly by any system of education; they come we know not when or
why, "forming a small band, a mere understanding of whose thoughts and
works is a test of our highest powers. A single English dramatist, and a
single English mathematician have probably equalled in scope and excel-
lence of original work in their several fields all the like labours of their
countrymen put together." 2

2 lies, Mathematics in Evolution. Pop. Sci. Monthly, 1876, IX. p. 207.

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But cannot we do something to increase the number of observers by tell-
ing them what to observe? It is probable that much may be accomplished
in this direction provided that care be taken to limit the field. Manuals
of "what to observe at the bedside and in the post-mortem room" are very
well in their way, but can never be made to reach the great majority of the
profession, nor would they be of much use if they did. If a few, a very few,
distinct specific questions are brought to the attention of the general prac-
titioner, he will often be on the alert for their answer. And it should be
remembered that chance may present to the most obscure practitioner an
opportunity for observation which the greatest master may never meet.

The great difficulty is to get such questions prepared. They must relate
to matters that are just in the nebulous region between the known and
unknown — to points not yet clear, but of which we know enough to make
it probable that by observing in a definite direction they can be made
clear; and to prepare them requires not only knowledge, but a certain
reaching out beyond knowledge. It usually happens that the man who has
this faculty strives to answer his questions himself; and no doubt he can
usually do it better than another. But much can be done towards defining
and marking out what we do not know, and this has been a powerful aid
to the progress of physiology in recent years.

I have had occasion to refer to this in speaking of Professor Foster's
work on physiology, in each section of which an attempt is made to separate
that which may be considered as proved from that which is merely prob-
able; and thus almost every page becomes suggestive of work to be done.

Another example of what I mean will be found in a paper on the collec-
tion of data at autopsies by Professor H. P. Bowditch of Boston (Trans.
Mass. Med. Legal Soc. 1, 1880, p. 139). Taking the results of an investiga-
tion into the absolute and relative size of organs at different periods of life,
and in connection with different morbid tendencies, recently published
by Professor Beneke of Warburg — Dr. Bowditch urges the securing as
large a number as possible of such data, and selects certain of Professor
Beneke's results for special inquiry; as for instance that "the cancerous
diathesis is associated with a large and powerful heart, capacious arteries,
but a relatively small pulmonary artery, small lungs, well developed bones
and muscles, and tolerably abundant adipose tissue." It can hardly be
doubted that those who read the papers of Professors Bowditch and Beneke
will be induced to examine things which before would have had for them
no interest, and therefore to make and record observations in pathological
anatomy which otherwise would have been lost.

The second difficulty referred to — viz.: the want of means for making
accurate records, is one that is yearly growing less. It behoves us to be
modest in our predictions as to what may be accomplished in the future

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towards the solution of our Sphynx's riddle. We see as through a glass
darkly, and except through the glass, in no wise; but at least we have made
such progress that what we do see, we can to a great extent so record that
our successors yet unborn can also see — and it is owing to this fact that a
part of the medical literature of the last quarter of a 19th century will be
more valuable than all that has preceded it.

The word-pictures of disease traced by Hippocrates and Sydenham, or
even those of Graves and Trousseau, interesting and valuable as they are,
are not comparable with the records upon which the skilled clinical teacher
of the present day relies. Yet how imperfect in many cases are even the best
of these records as compared with what might be given with the resources
which we have at our command. The temperature chart has done away
with the errors which necessarily follow attempts to compare the memory
of sensations perceived last week with the sensations of to-day — and the
balance and the burette enable us to estimate with some approach to preci-
sion the tissue changes of our patients by the records of change in the ex-
cretions which they furnish; but we must still trust to our memory, or to
the imperfect descriptions of what others remember, when we attempt to
compare the results obtained on successive days by auscultation or percus-
sion, although the phonograph and microphone strongly hint to us the
possibility of either accurately reproducing the sounds of yesterday, or of
translating them into visible signs, perhaps something like the dot and
dash record of the telegraph code, which could then be given to the press,
and so compared with each other by readers at the Antipodes.

We are beginning to count the blood corpuscles, and to use photomicog-
raphy, but we do not yet apply the latter process to the former so as to
enable every reader to count for himself.

The connections of medicine with the physical sciences are yearly be-
coming closer, and the methods by which these sciences have been brought
to their present condition are those by which progress has been, and is to
be, made in therapeutics as well as in diagnosis or in physiological re-
search. These methods turn mainly upon increasing the delicacy and ac-
curacy of measurements: of expressing manifestations of force in terms of
another force, or of dimension in space or time. The balance and the gal-
vanometer, the microscope and the pendulum, the camera, the sphygmo-
graph and the thermometer are some of the means by which investigators,
at the bedside and in the laboratory, are seeking to obtain records which
shall be independent of their own sensations or personal equations; which
shall be taken and used as expressing not opinions but facts; and with every
addition to or improvement in these means of measurement and record,
the field of observation widens, and new and more reliable materials are
furnished for the application of logical and mathematical methods.

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Upon the third difficulty which has been referred to, — viz: our confused
and defective terminology I need not dwell. "Science," said Condillac, "is
a language well made," and though this is far from being the whole truth,
it is an important part of it. In examining medical reports and statistics,
it is necessary to bear constantly in mind that to understand many terms
you must know what the individual writer means by them. When, for ex-
ample, we find in such statistics a certain number of deaths attributed to
gastro-enteritis, or croup, or scrofula, we have to take into account the
country, the period and the individual author in order to get even a fair
presumption as to what is meant.

The three difficulties which have been referred to, although the most im-
portant, are by no means the only causes of the confusion and imperfection
of our records.

Prominent among the minor troubles of the investigator are defective or
misleading titles; — and in behalf of the readers and bibliographers of the
future I would appeal to authors, and more especially to editors, to pay
more attention than many of them do to the matter of titles and indexes.
The men to whom your papers are most important, and who will make the
best use of them provided they knew of their existence, are for the most part
hard workers, busy men, who have a right to demand that their literary
table shall be provided with properly prepared materials and not with
shapeless lumps.

The editors of transactions of societies, whether these are sent to jour-
nals, or published in separate form, often commit numerous sins of omis-
sion in the matter of titles. The rule should be that every article which is
worth printing is worth a distinct title, which should be as concise as a
telegram, and be printed in a special type. If the author does not furnish
such a title it is the editors business to make it, and he should not be satis-
fied with such headings as "Clinical Cases," "Difficult Labour," "A Re-
markable Tumour," "Case of Wound, with Remarks." The four rules for
the preparation of an article for a journal will then be: 1. Have something
to say; 2. Say it; 3. Stop as soon as you have said it; 4. Give the paper a
proper title.

Some societies and editors do not seem to appreciate fully their responsi-
bility for the articles which they accept for publication, a responsibility
which cannot be altogether avoided by any formal declaration disclaiming
it. This is due to the fact that while the merits of a paper can usually be
determined by examination, this is by no means always the case. In every
country there are writers and speakers whose statements are received with
very great distrust by those best acquainted with them. Supposing these
statements to be true, the papers would be of much interest and impor-
tance; but the editor should remember that a certain number of readers,
and especially those in foreign countries, have no clue to the character of

OUR MEDICAL LITERATURE

137

the author, beyond the fact that they find his works in good company. In
medical literature, as in other departments, we find books and papers from
men who are either constitutionally incapable of telling the simple literal
truth as to their observations and experiments, although they may not
write with fixed intention to deceive, or from men who seek to advertise
themselves by deliberate falsehoods as to the results of their practice. Such
men are usually appreciated at their true value in their immediate neigh-
bourhood, and find it necessary to send their communications to distant
journals and societies in order to secure publication.

I presume that you are all familiar with the peculiar feeling of distrust
which is roused by too complete an explanation. The report of a case in
which every symptom observed, and the effect of every remedy given, is
fully accounted for, and in which no residual unexplained phenomena ap-
pear, is usually suspicious, for it implies either superficial observation, or
suppression, or distortion of some of the facts. A diagrammatic representa-
tion is usually much plainer than a good photograph, but also of much
less value as a basis for further work.

No fact is more familiar to this audience than the vast extent of the field
of the science of to-day — so vast that few may hope to master more than a
small part of it, and yet so closely connected that even the small part cannot
be fully grasped without some acquaintance with a much wider field.

But little over a hundred years ago, Haller in Gottingen was professor
of anatomy, botany, physiology, surgery, and obstetrics, and lecturer on
medical jurisprudence. At the same time he was writing one review a week,
and summing up existing medical science in his Bibliothecae. To-day any
one of these branches requires all the time of the most energetic and
learned of our contemporaries; but, on the other hand, the well-educated
medical graduate of to-day could give Haller valuable instruction in each
of the branches of which he was professor. It is also true, as I have pointed
out, that our actual progress is by no means in proportion to the work
done, nor as great as these merely quantitative statements would seem to
make it.

Science has been termed "the topography of ignorance." "From a few
elevated points we triangulate vast spaces, enclosing infinite unknown de-
tails. We cast the lead and draw up a little sand from abysses we shall never
reach with our dredges. If it is true that we understand ourselves but im-
perfectly in health, it is more signally manifest in disease, where natural
actions imperfectly understood, disturbed in an obscure way by half seen
causes, are creeping and winding along in the dark toward their destined
issue, sometimes using our remedies as safe stepping stones, occasionally,
it may be, stumbling over them as obstacles." 3

'"Border Lines of Knowledge," etc., by O. W. Holmes, Boston, 1862, pp. 7-8.

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In days of old, when the profession of medicine, or of a single medical
specialty was an inheritance in certain families, a large part of their knowl-
edge, and the efficiency of their remedies was thought to depend upon
these being kept a profound mystery. Among the precepts of magic there
was no more significant one than that which declared that the communica-
tion of the formula destroyed its power, and that hence attempts to reveal
the secret must always fail. We have changed all that. Every physician has-
tens to publish his discoveries and special knowledge, and a good many do
the same by that which is not special, or which is not knowledge. For the
individual, in a degree — for the nation or the race in a much greater degree
— the literature produced is the most enduring memorial. The whole re-
sult of civilization has been cynically defined as being roughly, "Three
hundred million Chinese, two hundred million natives of India, two hun-
dred million Europeans and North Americans, and a miscellaneous hun-
dred million or two of Central Asians, Malays, South Sea Islanders, &c,
and over and above all the rest the Library of the British Museum. This is
the net result of an indefinitely long struggle between the forces of men
and the weights of various kinds in the attempts to move which these
forces display themselves." 4

And thus in our great medical libraries each of the folios or quaint little
black letter pamphlets which mark the first two centuries of printing, or of
the cheap and dirty volumes of more modern days with their scrofulous
paper and abominable typography, represents to a great extent the life of
one of our profession and the fruit of his labours, and it is by the fruit that
we know him.

After stating that modern physicists have concluded that the sun is going
out, that the earth is falling into the sun, and therefore that it and all
things in it will be either fried or frozen, Professor Clifford concludes that
"our interest lies so much with the past as may serve to guide our actions in
the present, and with so much of the future as we may hope will be affected
by our actions now. Beyond that we do not know and ought not to care.
Does this seem to say let us eat and drink for tomorrow we die? Not so, but
rather let us take hands and help for this day we are alive together." To
this I join a verse from the Talmud which will remind you of the first
aphorism of Hippocrates, and is none the worse for that. "The day is
short, and work is great, — the reward is also great, and the master presses.
It is not incumbent on thee to complete the work, but thou must not there-
fore cease from it."

4 "Liberty, Equality and Fraternity," by James Fitz James Stephen, N.Y., 1873, p. 178.

Address to the Graduating Class of
Bellevue Hospital Medical College

I vaguely remember that once upon a time — a long while ago it seems,
for I look back at it across the gulf of a great war, in which the days were
like weeks, and the months almost counted for years — I spent one evening
on a platform in a large hall, in the character of a new graduate in medi-
cine. A part of the ceremonies on that auspicious occasion consisted of a
valedictory address to the graduates, delivered by the most eloquent mem-
ber of the faculty — an address which was highly praised, but of which I
have vainly tried to remember either the ideas or the phraseology. Fearing
that this specially localized loss of memory might be a symptom of a new
nervous disease which I should have to name and describe, I have consulted
several of my medical friends as to their experience in this respect, and I
am much pleased to be able to say that I have found very few who have not
totally forgotten the words of congratulation and of counsel given to them
when they received their diplomas.

Nor is the reason of this far to seek. The new doctor, in the pride and
vigor of youth, just stepping out of leading-strings, and realizing that he is
really his own man at last — standing at the threshold of that wonderful,
glittering world which beckons him on so enticingly, and in which fame,
and love, and wealth await his coming — this learned and skilful physician
is held back yet another hour, and compelled to listen to advice from one
whom he does not know, but who can surely have nothing to tell him be-
yond some well-worn platitudes about the dignity and honor of the profes-
sion which he has chosen, and that if he will be virtuous he will be happy,
or words to that effect. Small wonder then that, after a moment's attention,
his thoughts wander, and he drifts away on that beautiful river of revery
upon whose banks are Spanish castles unmatched by those of the Rhine or
the Danube, and which are in strange contrast to the practical, prosaic,
warehouse sort of a view which his orator is trying to present. If, therefore,
I observe five minutes hence that some of my special audience here, the
new graduates, are gazing reflectively upon some point of infinite distance,
or are evidently magnetized by some particular wave in the sea of this
other audience before me, I shall know that it is all quite as it should be,
and that my remarks are fulfilling their purpose.

Being unable, as I have just explained, to remember what was said to

Delivered March 15, 1882. Medical News (Phila) 40: 285-8 (1882).

139

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me by way of valedictory, and never having been present at a similar cere-
mony from that day to this, I thought it would be prudent to consult the
literature of the subject and find out what is usually said upon such occa-
sions. For this purpose I have examined about a hundred valedictory ad-
dresses, and have obtained from them a vast amount of instruction, and
some little amusement. From them I gather that this is an epoch in your
lives, that you are entering a remarkable age of the world's history (it is
customary here to allude to steam and electricity), that you live in the most
wonderful country under the sun, and that the eyes of the world are upon
you. All are agreed upon these points, and also as to the importance and
dignity of the science and art of medicine, and the necessity of continued
study on your part to keep pace with its advances. But the addresses are not
equally harmonious on all points. Some of them assert that the condition of
medical education in this country is not altogether satisfactory, that there
are some medical colleges (not, of course, the college of the graduates, but
some other medical college) which might be spared, that there are too many
doctors now, and more coming, and that some of these not only have not as
clear ideas about the precession of the equinoxes, or the authorship of the
book of Job, as a member of one of the learned professions should have, but
that there are even graduates in medicine (of other schools, of course), to
whom the addition of vulgar fractions is a stumbling-block, and correct
spelling vexation of spirit. On the other hand I find some who assert, first,
that the above statements are unfounded; second, that it is not necessary to
know how to spell correctly in order to cure the chills or set a broken leg;
and third, that the demand for higher medical education is essentially a
pernicious aristocratic movement, calculated to oppress the poor, and pre-
vent them from obtaining the sheepskins so desirable to cover their naked-
ness. As, however, I am sure that all of you are just now strongly in favor
of higher medical education, without regard to what you may have thought
about it a few weeks ago, or what you may think of it a few years hence,
when you get a little steam-hatching machine of your own, I feel that I shall
most contribute to the harmony which this occasion demands by — entirely
agreeing with you.

Upon the whole, I came to the conclusion that on this occasion it is
safest to talk platitudes; in fact, I must do this if I am to advise you as a
body. The inexorable laws of statistics tell me that among you are those
having the most diverse capacities, purposes, and destinations. Two or
three of you will go on with your studies for the next ten or fifteen years,
observing, experimenting, reading, and comparing, until some fine day
you will know something that other people don't know, and will become
writers and teachers, leaders in your profession, famous in your day and
generation. One or two of you may become popular physicians, for whom
being called in consultation is an everyday matter, and a large income a

ADDRESS AT BELLEVUE HOSPITAL

141

matter of course. Many of you will become plain, solid, common-sense prac-
titioners, who will do a vast amount of good, be indispensable to the com-
fort and safety of the community, and be happy because satisfied, which is
more than I can predict of the others. A few will abandon medicine because
it does not pay, and turn to some occupation of better promise. And one
or two will slip farther and faster down the broad, smooth path of dissipa-
tion on which their feet have already taken the first step, and will pass on
to the inevitable end.

Fortunately for all of us, nobody knows who are to be the black sheep
and who are to win the prizes. Each of you must live out that which is in
your brains and blood, the result of generations gone before; but, you have
also to live out that which you yourselves add to the inheritance.

Now you are going out to Vanity Fair duly armed and equipped, and
provided with maps and guide-books of the latest and most approved edi-
tions. Probably you will never again be so fully conscious of, or so thor-
oughly satisfied with, your knowledge of the science and art of medicine as
you are to-night. What would I not give now to know as much as I thought
I knew the day I received my diploma. And yet the seven world problems
of Du Bois-Reymond are still unsolved.

I congratulate you on your prospects. Shall I tell you what some of them
are? Our American life will present to you as much variety, as vivid con-
trasts, as subtle mysteries, and as many giants, demons, and sirens to be
overcome or outwitted as any that the legends of old depict. No doubt you
will soon come across some of that curious sect, the antis, who are beginning
to make their appearance amongst us; antivaccinationists, antivivisection-
ists, anti-anything, so that it gives them an excuse to keep their names be-
fore the public. And when you are asked how you account for the volumi-
nous statistics and startling facts which some of these antis produce so
rapidly and easily, you may hesitate a little, unless you have heard the
celebrated conundrum which I am about to give you. A little boy said,
"That girl is the daughter of my father and my mother, but she is not my
sister. How do you account for that?" And the answer is (this is strictly con-
fidential), that the little boy lied. Taking them all in all, these antis are a
curious class of cranks, worthy of careful study on the part of some of our
experts in mental diseases, during the brief intervals in which they have no
medico-legal case on hand. Some of them are quite honest in their convic-
tions, and all are very theological and emotional in their appeals, and to
this they owe what success they have in achieving notoriety; and yet, while
professing the most humane sentiments, they are unscrupulous even to
cruelty in carrying out their fantastic ideas. They will not greet your com-
ing on the stage of action with any particular enthusiasm, but you must not
be discouraged on that account.

You will find, also, that the manufacturing pharmacist is abroad in the

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land, and that he, on the other hand, will be very glad to make your
acquaintance. He will not only supply you with toothsome preparations,
neatly put up in artistic packages, but he will tell you what they are good
for, in what doses to use them, and, most important of all, which of them
are in accordance with the code of ethics. He will ornament your office
with innumerable samples, and pleasantly interrupt and variegate the pe-
rusal of your medical journals by means of blue, green, and yellow adver-
tising sheets, unexpectedly and neatly inserted. Under his friendly guid-
ance the path of medicine becomes a flowery one, for all that you have to
do is to decide upon the name of the disease of your patient, and then look
over the advertisements and samples to see what will cure it.

Moreover, there are some canvassers, and publishers and editors, who are
prepared to be your best friends if you will only permit it. They want you
in the first place to subscribe, and then to write; to produce from the stores
of your knowledge, items, and essays, and papers, to help them to raise the
standard of American medical literature, until it shall be high above that
of the effete despotisms of Europe. Nor are these the only persons who
await your coming. You are wanted in Medical Societies, the advocates of
higher medical education rely on your support, Boards of Health and Reg-
istrars are looking to you to make their statistics perfect and complete, and
Army and Navy Medical Examining Boards are preparing fresh lists of
questions for your benefit. But perhaps you flatter yourselves that you have
now passed your final examination. Never was a greater mistake. Your most
severe and continued ordeal is just about to begin. And it may be that the
result will give rise in some of your minds to serious doubts as to the value
of the Darwinian theory about the survival of the fittest. But at all events
I can assure you that you need have no fear as to there not being room for
you, or that the world has not work enough for you to do. You know the old
saying, "There is always plenty or room on top." But even in the lower
stories there is plenty of standing room. There are to-day between one and
two millions of sick persons in the United States, and the deaths for this
year will certainly be a million. You see, therefore, that the sanitarians,
whom some of you may, unwisely, look upon as enemies, since they are try-
ing to do away with some of the causes which necessitate your services, have,
at all events, not yet seriously injured the business of the profession. And
for your further encouragement I will predict that it will be a long time
before they succeed in doing this, for whatever variations the changing
seasons bring to our other harvests, the fool crop continues with almost un-
varying regularity.

While I am on this subject, however, let me advise you from the business
point of view, as well as on account of your interests as citizens and humani-
tarians, to look into this matter of preventive medicine a little more closely

ADDRESS AT BELLEVUE HOSPITAL

143

than you have yet probably had time to do. It is going to be a very impor-
tant matter in your day and generation, and you will be examined and
cross-questioned on it to an extent which you little suspect. Some of you
will no doubt be called to act as members of Boards of Health, and all of
you are sure to be appealed to on questions of ventilation, house drainage,
school hygiene, pure water, adulterated food and drugs, and the means of
shunning or putting away the pestilences, which will consume, not only
the children of other people, but your own also, if you cannot answer the
sphinx's riddle.

You will find that public health legislation is a matter to which you can-
not remain indifferent, for you will become part of the machinery whether
you wish to or not, and if you are wise you will study the subject so that you
can aid in shaping this legislation to what it should be, for in this respect
knowledge is power. If you leave the matter to sentimental enthusiasts and
professional office-seekers, you will find that it will turn out like the Irish-
man's ale — it will thicken as it clears. One of the matters just alluded to
touches your professional work very nearly, and that is the adulteration of
drugs. If you practice in a large city, this is not of so much importance,
since you can always readily find first-class pharmacists, upon whose prepa-
rations you can rely, but away from the great centres, the case is different.
Unless you can depend upon getting what you call for in your prescription,
what success can you hope for? and yet unless you know what apothecary
is to fill that prescription, you cannot rely upon it. And it is always wise not
to conclude that your treatment has failed until you have made sure that
what you ordered has really been given.

And in this immediate connection, permit me to remind you why the
hyrax has no tail. It is written in the mystic volume of St. Nicholas that
when the world was about being completed, notice was issued to all the
beasts that, if they would go to the Court of the King on a certain day, they
would be handsomely finished off with tails. All were pleased with the pros-
pect, but the hyrax was especially delighted. Now when the appointed day
came, it was cold and rainy, and the hyrax did not like to go out in bad
weather. So he stood in his door and asked the lion and the wolf and several
others to bring him his tail, and they all promised to attend to it. But they
all forgot it; and when the hyrax went himself the next day to see about it,
he found that the supply of tails was exhausted. That is why the hyrax has
no tail, and if you rely on what other people tell you that they have done,
or are going to do, for you, the result will probably be about the same.

And just here permit me to give you an entirely new bit of advice; at
least, I did not find it in any of the valedictories I read. You will, of course,
never ask a man who is not acquainted with you personally to give you
recommendations or testimonials; but see to it that you yourselves never

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sign a recommendation for a man whom you do not know. Do not be per-
suaded or bullied into doing this by people whom you know, for people
whom they know, but you do not. If you wish your name and opinion to
have any value in the eyes of other people, respect them yourself.

Do not be in a hurry to write or teach. The American press has been said
to be chronically premature, and the same may be said of a good many
graduates — not, of course, of this school, but of some other schools; and not
only in this country, but in other countries. There are a great number of
men, in all professions, and in all parts of the world, of whom it may be
truly said, that if they knew more, they would say less. Try to know some-
thing of all branches of science, for they all throw light upon your work;
and at the same time try in some one branch in your own special field of
study to know more than anybody else, and to be sure that you really do
know it. This is not so difficult as it may seem. You will not have to go far
in any direction before you will come upon that which is doubtful or un-
known— questions which as yet have no answers. And if, during your pupil-
age, you have learned to think, and are not, as Holmes phrases it, merely
"phonographs on legs," the rest is a mere matter of detail, and this advice
is not difficult to follow. Hesiod said that in his day there were three kinds
of men — those who understand things of themselves, those who understand
things when they are explained to them, and those who neither understand
things of themselves nor when they are explained to them. That was the
classification in Greece over two thousand years ago, but it is a convenient
one for use even now; and when a man has settled for himself to which class
he belongs, his education has taken a long stride.

Each of you has his aspirations — a little vague, no doubt, but none the
less real. Keep them as long as possible, and, above all things, do not assume
or affect a cynicism which belongs neither to your age nor your experience.
Second-hand misanthropy is like a second-hand Chatham Street coat: it
never fits. No doubt you all desire to make money; not for the money's sake,
but for what you can do with it. It is not a desire to be ashamed of, and the
business side of your profession demands your careful attention. But mark
this: The best works in this world are not done for money, or from selfish
motives of any kind. And if you are to achieve true success — the success
which brings happiness, and is the only kind worth seeking — you must do
a vast amount of work, not for money, but in part because you like it, and
in part because it will do good and help others. Do not wait for the oppor-
tunity to do some great thing. Take hold of the work that lies next your
hand; work which you can do, and which ought to be done — it will be very
strange if there is not always something of that sort waiting for you; and do
not dawdle, and defer, and lose the good, in a vain waiting and longing for
the best.

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145

Be healthy, brave-hearted, and joyous. Physical health is unfortunately
not contagious, but mental and moral health is. Avoid second-hand philos-
ophy, sickly complainings about the evils and miseries of life, and small
beer of all kinds. No doubt you will find many of your golden dreams fad-
ing into gray mists; but, on the other hand, you will be continually stum-
bling against solid realities, which are quite as good as any dreams if you
only recognize the opportunity. Labor and trouble you must meet; but of
the first you can for the most part make a pleasure, and the second should
not be pampered and made a luxury of. Never pity yourselves. Do not waste
your time in vain speculations as to the why. Remember that bitter little
poem of Heine's:

"By the sea, by the dreary, darkening sea, stands a youthful man,

His head all questioning, his heart all doubting,

And with gloomiest accent he questions the billows.

Oh, solve me life's riddle, I pray ye, the torturing ancient enigma

O'er which full many a brain hath long puzzled

Tell me, what signifies man? Whence came he hither?

Where goes he hence? ....
"The billows are murmuring their murmur unceasing,

Wild blows the wind, the dark clouds are fleeting,

The stars are still gleaming so calmly and cold,

And a fool is awaiting an answer."

In the majority of valedictory addresses which I have examined, there
was more or less special advice about medical ethics, and a word or two on
this subject is therefore not out of place. The code — or perhaps I should
now rather say the codes — of medical ethics are great mysteries to the public
at large. By many it is supposed to be a sort of trades-union set of rules de-
signed to protect the business interests of physicians, without any particular
regard to the rest of the world. I need hardly say to you that this is not true.
It may be summed up in this, that a physician should be a gentleman, and
should treat other physicians and his patients as he would wish to be treated
under like circumstances. And your duty in this matter is to attend to your
own ethics and not those of other people. Medicine is not a rigid system
of rules and formulas as it was in ancient Egypt; a fixed creed to which you
are to subscribe, and from which you must not vary. It is a living, growing
thing, making use of every resource which the progress of science brings;
it is truly eclectic and catholic, testing all things, and holding fast to that
which is good. It is not a system which forbids the use of any particular
remedy, or limits its followers within the narrow bounds of any sect or ism.
There are such systems, and there are a few men who advertise themselves
as followers of such systems, and who really do follow them. There are also
many men who so advertise, but who really do not follow them. Some of

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these last are well-educated physicians, "but they are — that is to say, from
the point of view of a gentleman, they must be considered as — in short, the
more you know of their methods the more fervidly you will assent to what
I have not said about them."

One of the latest authoritative expressions of opinion on this subject is
the following resolution recently adopted by the Royal College of Physi-
cians in London:

"While the College has no desire to fetter the opinion of its members in
reference to any theories they may see fit to adopt in connection with the
practice of medicine, it nevertheless considers it desirable to express its
opinion that the assumption or acceptance by members of the profession
of designations implying the adoption of special modes of treatment is op-
posed to those principles of the freedom and dignity of the profession which
should govern the relations of its members to each other and to the public.
The College, therefore, expects that all its fellows, members, and licentiates
will uphold these principles by discountenancing those who trade upon
such designations." This last sentence touches the root of the difficulty.
Those who trade upon such designations. Let us take a concrete example.
You treat a case of pemphigus with arsenic. You may theorize as you like
about the essential nature of pemphigus; you may select arsenic because
you think it would produce the disease, or because you think it produces
something contrary to the disease, or for no reason whatever beyond the
empirical fact that you have seen a case of pemphigus recover under the
use of arsenic. Also, you may give this arsenic alone or combined with other
substances, and in any doses that you please, from the decillionth of a grain
to a grain, and you may explain the results as you like. But as an educated
physician, and a gentleman, you may not advertise yourself as an arsenio-
pemphigist, and denounce every one who does not adopt your theory and
practice, and as there is a good deal of common-sense truth in the old adage,
that a man may be known by the company he keeps, you will not have
more to do than you can help with the men who do so advertise themselves;
and still less will you have to do with those who advertise themselves as
antiarsenio-pemphigists, and then treat their cases with arsenic after all,
and claim the results as due to dynamized brickdust.

And please observe that this is all that you have to do. You are not to en-
ter into controversies with them or about them, you are not to repine over
their success or exult over their failures. They have another code of ethics
from your own; that is all that need be said about it. Thus far I have been
speaking of fairly educated sectarian physicians. As to the ordinary, un-
educated, and bill-distributing quack, with his sure cure for cancer, or his
pure vegetable specific for coughs, rheumatism, and dyspepsia, you may be
sure that in the long run he will make rather more business for you than

ADDRESS AT BELLEVUE HOSPITAL

147

he takes away. Do not fall into the error of supposing that legislation can
prevent the existence of this class of men, or that you need the protection
of the law against them. The public interest demands such protection, if
for no other reason than to secure a proper registration of the causes of
death of all citizens, and it is not only your right, but your duty, to call the
attention of legislators to these interests, but never seek protection on your
own account.

Be honest to yourselves as well as to other people, and do not be afraid
of admitting that you do not know, or feel bound to attempt an explana-
tion of all that you see or do. He who would know anything thoroughly
must be content to be ignorant of many things. Try to define to yourselves,
as clearly as possible, your own ignorance; it is the first step towards reme-
dying it, and be sure that the modest student, whether he be undergraduate
or learned professor, will everywhere meet with helping hands in the great
brotherhood of science.

There are many men who are honest in purpose, and yet who are con-
stantly, although not consciously, untruthful; they see that which they
think they ought to see, and not that which is.

I am reminded that this is a valedictory address, and that in it I must bid
you farewell. This I do in behalf of your teachers, whose unavailing regrets
that they are not to have another opportunity of meeting you in the ex-
amination-room, you can imagine much better than I can describe. What
they could do for you they have done. And now, as Emerson says, "We have
accompanied you with sympathy, and manifold old sayings of the wise, to
the gate of the arena, but 'tis certain that not by strength of ours, or of the
old sayings, but only on strength of your own, unknown to us or to any,
that you must stand or fall." You may be sure of our best wishes for your
success and happiness.

"Who misses or who wins the prize, go lose or conquer as you can;
But if you fall or if you rise, be each, pray God, a gentleman."

But while I bid you farewell as students, I also bid you welcome to the
ranks of the profession. And I can assure you, that upon the whole, you are
coming into very good company. If in anything I have said this evening I
have seemed to speak lightly of the medical profession or its adjuncts, I
hope it will not be construed as more than the ordinary banter in which we
boys sometimes indulge when we get off in a corner by ourselves.

I have much faith in the advice of that anonymous writer who said —

"Oh, never wear a brow of care, or frown with rueful gravity,

For wit's the child of wisdom, and good humor is the twin.
No need to play the Pharisee, or groan at man's depravity;

Let one man be a good man, and let all be fair within.

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JOHN SHAW BILLINGS

Speak sober truth with smiling lips; the bitter wrap in sweetness,

Sound sense in seeming nonsense, as the grain is hid in chaff.
And fear not that the lesson e'er may seem to lack completeness,

A man may say a wise thing, though he say it with a laugh."

It is true that you are entering, nay, in your medical studies you have
already entered, a world of labor, and pain, and sorrow. You will see how
the destruction of the poor is their poverty, and how the sins of the fathers
are visited upon the children; how neither culture, nor wealth, nor power,
can forever put off the evil day; and how there is, at last, one event to all
sons of men.

You must be prepared to deal with anxiety, fear, grief, and despair, as
well as fever and physical pain; you are to be not only physician, but friend,
confessor, guide, and judge, and you cannot avoid these responsibilities if
you would, nor should you if you could.

Nevertheless, I can assure that you are also entering a beautiful world,
where the very shadows prove that plenty of sunshine exists, a world of
brave men and good women, whose best and noblest characteristics are
brought out most clearly and vividly in such scenes as those in which you
will be called to act. But remember, that as a rule, you will find only what
you seek and believe in. Remember, also, that this knowledge which you
have acquired, and are yet to acquire, is entrusted to you as a power, a
power none the less real, and involving no less responsibility because it is
accompanied by no special outward insignia of authority or rank.

By the help of this knowledge you are to get wisdom — that wisdom which
always lingers, and sometimes comes too late; that wisdom of which it is
written that for all the children of men "length of days are in her right
hand, as in her left hand riches and honor."

Medical Bibliography

Mr. President and Gentlemen of the Faculty:

First of all, permit me to return thanks for the honor of being called
upon to address you at this Annual Meeting, and also for the distinction
of an election as an Honorary Member of this body. As regards the latter,
my thanks are unqualified; as regards the former, I am reminded of
the comparison of such honors to that little book described in Revelation
as being "sweet in the mouth but bitter in the belly," since the prepara-
tion of such an address as one would wish to present to this assemblage,
is by no means an unmixed pleasure; and if my reflections while
hesitating in the choice of a subject for this occasion could be given in
full, they would illustrate this capitally.

I thought of a number of things which would probably interest you, at
all events I should very much like to hear something about them my-
self; but, unfortunately, I knew just enough about them to deprive me
of that unhesitating confidence with which one can advise about matters
of which he is quite ignorant, — and yet not enough to feel that I had
anything to say about them which would be worth listening to.

Once upon a time — many years ago it was — I had a patient! This pa-
tient was a locomotive engineer, who ran the night express on one of our
great Western through-lines. He told me that on dark and stormy nights
he drove his engine into the blackness ahead without special anxiety or
fear, but on the moonlight nights, when the vista into which vanished
the glittering rails in front was half revealed, and when the bars of
shadow across the track seemed like missing rails or fallen tree-trunks,
he was fearful and hesitating, and that the nervous strain then became
great and exhausting. It was a new illustration of the old proverb,
"Where ignorance is bliss," etc.

But to return to my subject, or rather to my want of a subject. I
thought of matters of local interest, of the relations of physicians to
public health, the management of smallpox epidemics, and the Baltimore
Ordinance for the Control of Contagious Diseases; of the vital statistics
of Maryland, and a comparison of the results obtained by the census with
those which may be deduced from a multiplication of the supposed
number of houses by the estimated number of persons per house; of

Address at the 85th Annual Session of the Medical and Chirurgical Faculty of
Maryland, held at Baltimore, April 1883. Transactions of the Medical and Chirurgical
Faculty of Maryland, 1883. pp. 58-80.

149

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JOHN SHAW BILLINGS

higher medical education, and the probable relations the Medical De-
partment of the Johns Hopkins University will have to it and to other
medical schools in this city; of hospitals in general, and the merits and
demerits of the Johns Hopkins Hospital in particular; of quarantine
versus scientific investigation, and the National Board of Health versus
the Marine Hospital Service; and the result of these reflections was that
the progress of science and the harmony of this auspicious occasion would
be best aided and preserved by letting all these subjects carefully
alone. "Let us remember," said Whewell, "that we are not infallible, not
even the youngest of us," and in all these matters let each abide in his own
belief; that is, of course, provided that we cannot persuade or drive
him out of it.

Finally, I decided to occupy the time with a talk about medical bibli-
ography and how this Faculty can promote it. The trouble did not end,
however, with the selection of a subject; far from it. Do you remember
Fuseli's description of his method of painting a picture? He said, "First I
sits myself down; then I works myself up; then I puts in my shades; then
I drags out my lights." This sounds simple and easy; but, in the first
place, I could find no time or opportunity to sit down to this business
until a few days ago. As to the working up — let me take you behind
the scenes for a moment, and in the strictest confidence show you how it
was done.

In the first place, a sheet of foolscap was covered with notes of head-
ings, such as "definition," "utility," "history," "necessity for truthful-
ness," "difference between a bibliography and an index," "method of
work," "how to use a library," etc., etc. Then I wrote out more fully the
few ideas I had derived from personal experience. Then I took up the
Index Catalogue of the Washington library and turned to the heading
"Bibliography (Medical)." In this particular case I happened to know
pretty well what I wanted, which was a list of three or four of the first
attempts at medical bibliography, and the precise reference to a paper
on "errors in medical bibliography," by Dr. A. Petit, which I had
found very interesting. I also knew that I had read, within the past year,
another article on the same subject by the same author, being a reply to
an article by M. Richet in the Revue Scientifique. To find the precise
reference for this I went to the Index Medicus, and in five minutes I
had it. Having examined these various papers, I found half a dozen more
references which were neither in the Index Catalogue nor the Index
Medicus, and, especially, one to a preface written by Prof. Verneuil to a
treatise on gastrostomy, by M. Petit, to which I shall have occasion to
refer presently, and which is probably in about the last place where
one would have thought of looking for one of the most eloquent
eulogiums of medical bibliography with which I am acquainted.

MEDICAL BIBLIOGRAPHY

151

Having read these various papers, together with the very excellent
article on Bibliography in the last edition of the Encyclopedia Britan-
nica, I discovered three things, all of which previous melancholy ex-
periences had led me to anticipate. First, I found a number of fresh
references; second, that I had more material than could be used in an
hour's address, and third, that most of the ideas contained in my pre-
liminary notes had been very much better expressed by previous
writers, and that they must either be dropped, or quotations substituted
for what I had thought might possibly be something new.

I shall not trouble you with further details, my object being merely to
indicate one method of commencing a bibliographical research; and also
to indicate why it is that such researches tend so strongly to destroy
originality of expression, since one so often finds a sentence or paragraph
in which his idea is so well stated that any change in it would be the
reverse of an improvement, and the impulse to quote becomes irre-
sistible, although the quotation is by no means always acknowledged.

Now, like the fine old Scotch gentlewoman quoted by John Brown,
one often finds that the best way to get the better of temptation is just to
yield to it; which is simply another way of stating what some modern
philosophers would express as the importance of following the lines of
least resistance; and therefore you are duly warned that I shall make no
special attempt at originality, either in matter or form; and while I do
hereby formally apologize for not having prepared a set oration, I do,
at the same time, beg that you will shift the greater part of the blame for
this failure from my shoulders to those of the gentlemen who are re-
sponsible for my being in this position.

Bibliography is defined by the Encyclopcedia Britannica as "the science
of books, having regard to their description and proper classification,"
the meaning having been greatly modified from that which it had a
hundred and fifty years ago, when it signified "skill in deciphering and
judging of ancient manuscripts," which is now called palaeography.
This definition of the Encyclopaedia, comprehensive as it is, does not
fairly include the most usual sense in which the term bibliography is
now used as applied to a particular subject, that is, as giving references
to all the literature of that subject: including not only the titles of
books and pamphlets specially treating of it, but also articles in periodi-
cals and transactions, and even single paragraphs which furnish informa-
tion with regard to the matter in hand. Perhaps I can best illustrate this
by giving a few specimens of the inquiries made at the Library of the
Surgeon General's Office in Washington, such as: "for the literature of
hydrophobia"; "for all cases of epilepsy reported as cured by burns";
"for a complete list of all books and papers written by Dr. John Jones";
"for materials for the life of Dr. John Morgan"; "for a list of the

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printed medical theses of the graduates of the University of Pennsyl-
vania"; "for materials for a history of the Medical Schools of Baltimore,
including all catalogues, announcements, etc."; "for all accounts of
epidemics occurring in Memphis"; "for data relative to the diseases of
Georgia"; "how many editions have been published of the treatise of the
school of Salernum?" "Which is the best edition of Galen?" "Who was
the author of Sechs BiXcher ausserlesene Artzney, etc., published at Tor-
gau in 1600?" "Where can I find a paper 'On the voice' by Dr. H. H.
Hayden, published in some journal or transactions forty or fifty years
ago?" "Where can I find a paper 'On the differences between dead and
living protoplasm,' recently published, author's name not remem-
bered?" "What is a copy of Bagellardus de Egritudinibus infantium
worth?" "What will you give for a perfect manuscript in good condition,
written in 1429, being extracts from and commentaries on Almansor and
Isaac, and making 160 leaves folio?" The answers to these and similar
questions come under the head of medical bibliography, and you will see
that it is not easy to give a definition which will include them all, unless
you make it so general and vague as to be useless, as, for instance, that
it is the science of medical literature. It may be viewed and studied
either as a means or as an end. The greater part of medical bibliogra-
phy does not go beyond the titles of books or articles. The first distinct
and separate work on the subject is that of Pascal Lecoq, better known
by his Latinized name of Paschalis Gallus. His Bibliotheca Medica, pub-
lished at Basle in 1590, gives a list of about thirteen hundred medical
authors, the titles of whose works are stated vaguely and indefinitely,
usually only one edition being given. It is arranged alphabetically by the
first, not the last names of the authors. It gives, also, lists of writers on
certain subjects or in certain languages, and as the system of classification
is brief and curious, I give it in full: Works in French, works in German,
works on Hippocrates, on Galen, on Avicenna, on Dioscorides, on Sur-
gery, Anatomy, Materia Medica, Pharmacopoeias, on Practice, on Con-
silia Medica (or what we would call clinical medicine), on Pest and on
Lues.

In the following year, namely, 1591, Israel Spachius published, at
Frankfort, his Nomenclator Scriptorum Medicorum. This is a subject-
catalogue with an index of authors, of whom 1436 are mentioned. The
data for both these books appear to have been derived mainly from the
Bibliotheca of Conrad Gesner. Cuvier, in his life of Gesner, in the
Biographie Universelle, mentions that Gesner never permitted the sec-
tion "Medicine" of his Bibliotheque Universelle to be printed, as he
could never get it arranged to his satisfaction. If this rule were to be
generally applied, bibliographies and catalogues would be exceedingly
rare. I shall not inflict upon you an account of the various attempts at

MEDICAL BIBLIOGRAPHY

153

medical bibliography which have been published from the time of Spa-
chius to the present day. You will find their titles down to 1874 in the
very complete and accurate Bibliographic des Sciences Medicales, by
Paully, which is itself a book worth knowing, being a bibliography of
medical bibliography, history and biography, making a volume of over
1800 pages. I must, however, say a word upon one series of works, not to
mention which would be unpardonable, for an address on medical bib-
liography which contained no allusion to the Bibliotheca of Haller
would be like a political speech of the present day with no allusion to
reform or the tariff. The quarto volumes which contain Haller's Biblio-
thecce Anatomica, Chirurgica and Medicince, comprise a remarkable
piece of work, which only those who have been engaged in similar pur-
suits can fully appreciate. They form a history of medicine rather
than a bibliography; but it is wonderful that remote as he was from great
libraries, he should have been able to make such a complete enumera-
tion of existing medical books as he did. These works are, however,
much more generally praised than consulted for bibliographical pur-
poses; the arrangement in order of dates, instead of by subjects, or alpha-
betically by authors, being very inconvenient, and the index being im-
perfect. Their great value is in the clear, brief analyses and pithy criti-
cisms which are given of a large number of books, and in the fact that he
clearly indicates the books which he himself has seen and examined, as
distinguished from those of which he knew only the titles. With refer-
ence to these last he usually indicates his authority, but, unfortunately,
in printing he forgot to give the key to his abbreviations, and some of
these are now unexplainable.

Mr. Thomas Windsor, of Manchester, one of the most learned and
accurate of living medical bibliographers, has pointed out an amusing
error resulting from misinterpreting Haller's abbreviations. "Speaking
of Peter Lowe's work, The Whole Course of Chirurgie, Haller gives the
editions as follows: 'London 1597. 4. Tr. 1612. 4. Port. 1614. 4. Gunz.
1634. 4. Port. 1657. 4. Gunz.' That is, there were five editions, published
in the years 1597, 1612, 1614, 1634 and 1657. All were issued in London,
and all were quartos. The abbreviations Tr., Port., Gunz., signify the
authorities for Haller's statements, he himself not having seen any copy
of the work. Watt, in his Bibliotheca Britannica, vol. I, p. 618, has ampli-
fied Haller in the following extraordinary manner: 'Lowe, Peter . . . The

Whole Course of Chirurgerie Lond. 1596, 1597, 1612, 1634, 1654, 4to.

This is considered to be a book of very great merit, and was translated
into a variety of languages, and printed in Fr. 1612, Port. 1614, Gunz.
1634, Port. 1657.' Allibone, in his Critical Dictionary of English Litera-
ture, has carefully copied Watt." 1

1 Index Medicus, Vol. I, 1879, p. 372.

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JOHN SHAW BILLINGS

It is not my purpose to indicate or comment on the various systematic
works on medical bibliography which have appeared since the days
of Haller, all of which are largely indebted to his works for information.
Most of them are more useful to a librarian or bookseller than they are
to a physician seeking for information on a particular subject, unless that
subject is bibliographical. The best medical bibliography will be found
in the French dictionaries or encyclopaedias of medicine, in monographs,
and articles in medical journals. I shall presently, however, have a word
or two to say with regard to one source of information, namely, cata-
logues of medical libraries; but first let us consider some of the meth-
ods used in medico-bibliographical work.

First, there is the old-fashioned way, in which the student searches the
books immediately at his command, using their indexes and making
notes of all references to other works. He then goes to a library —
asks for these books, gets more references from them, and so on — his
time and patience being usually exhausted some time before the supply
of references fails. It is in this way that bibliographical research becomes
a pleasure by and for itself, and it is thus also that the best of this
work has been done, but it requires much time.

Second, there is the modern mechanical way, the extreme type of
which is to pay some one else to make a list of references for you, and
then print this list as a bibliography of the subject without taking the
trouble to consult the works themselves. Some writers, in fact, seem to
desire to finish their article with an imposing string of references, with-
out caring much whether they have any special relation to the matter
in hand or not, something like the retired merchant who bought a
country place and resolved to have a cow because he was so fond of
new-laid eggs.

Do not suppose, however, that I object to mechanical bibliographical
work; it is of great use as saving the time of those who can be more use-
fully employed, and it is now in fact a necessity, — since the mass of ma-
terial to be dealt with is too great in most cases to be handled in any
other way. I only wish to reiterate warnings which have already been
given by others. Sir James Paget, for example, thinks that "there is now
a danger that in the multiplication of scientific pursuits, and in the
superabundance of means of publication, we shall lose the accuracy
which should be at the foundation of our work. The publishing of error
is quite as easy as the publishing of truth, and there will always be a
large number of persons who will believe a statement because it is in
print."

Again, in an excellent article signed "Ch. R.," in the Revue Scientifique
for July 1, 1882, it is urged that an indispensable condition in biblio-

MEDICAL BIBLIOGRAPHY

155

graphical work is sincerity. "It is almost a lie to quote a book which one
has not had in his hands," and, again, "It is a part of elementary scien-
tific honesty to cite only the books which one has read. ... Of course one
can neither consult all authors nor have at his disposal all the collections
and books which contain desirable information; but if one cannot consult
the original record, there is certainly nothing to prevent stating that
a given bibliographical note is given at second-hand, and noting the
authority for it. A good bibliography, however, should merit more
praise than the mere statement that it is not deceptive. After all the data
and materials have been collected it will be found that many items
are useless, and it is the elimination of these useless references which
forms an important part of true erudition." M. Richet would not have
such references mentioned at all, he would have the writer ignore them
entirely. This view, however, does not appear to me to be correct,
so far as concerns the titles of books or papers which might seem to a
person unacquainted with them to relate to the matter in hand. When
in the course of his researches a writer has examined such a book or
pamphlet and found that it contains nothing original, or that the
contents do not correspond with the title, or that for other reasons it is a
waste of time to consult it, he should give the reference and note the fact
distinctly. It is often just as important to indicate that there is no
thoroughfare as to point out the direct road. It is precisely this critical
indication of the value of a paper which makes the difference between
good and bad bibliography, or between bibliography, properly so called,
and catalogues or indexes. Consider for a moment what is, or should be,
the main purpose for which a writer gives bibliographical details,
namely, to save his reader time and trouble in case he wishes to verify
or enlarge upon the author's statements. But if the writer has consulted
John Smith's book or article and found that it gives no information in
regard to the subject in hand, although its title seems to indicate it; that
it is a mere rehash of opinions without any new facts, any intelligent
criticism, or anything else which would induce one to look at it if he had
no other sources of information, he should say so, and spare his suc-
cessors in the same path the labor of looking up and reading John
Smith's work, and the moral deterioration which the feelings excited by
the examination of such a work are apt to produce.

It is very true that when one is speaking of the works of contemporaries
and friends there is a very natural and even commendable reluctance to
publish unfavorable criticisms or comments, and that it is much easier
to refrain from all mention in such cases; but at least it should be done
for the older writers when an attempt is made to present a bibliography
properly so called. The article of M. Richet, to which reference has just

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JOHN SHAW BILLINGS

been made, gave rise to an interesting comment by M. Petit upon the
method to be pursued in bibliographical researches, in which he points
out the impossibility of preventing literary thefts in bibliographical
work, and refers to the "wrath of Broca and Jaccoud at this factitious
erudition, and at the fact that their work has been used by others without
acknowledgment." (Petit (L. H.) Sur la m^thode a suivre dans les
recherches bibliographiques. Gaz. hebd. de med., Paris, 1882, 2e s£r.,
tome XIX, pp. 537; 585.)

Jaccoud prefaces his bibliography of diabetes as follows: "The gen-
eral bibliography of diabetes has been thus far a little neglected. I
have taken special pains in preparing the following, and have arranged
it on a new plan which I think will much increase its usefulness. I hope
that whoever does this bibliography the honor of copying from it, will
at the same time indicate the original of the copy."

On reading this note I was naturally led to an examination of the
bibliography thus commended, and certainly it shows extensive research
and is a very useful compilation. I note in it, however, some errors of
matter and form, and as by these I can illustrate one or two rules of
bibliography, I will occupy two minutes with some remarks on the first
of the ten pages of which this list consists. The merits of a bibliography
are to be judged of: 1st, as to its accuracy; 2d, as to its completeness; 3d,
as to absence of redundancy or repetition; 4th, as to its form; the most
important rules for which last are, that it should be such that a librarian
or a bookseller can find the books called for with the least expenditure
of time and trouble, and that the classification shall be such as will
direct the inquirer most readily to the especial information which he
seeks.

First, then, are the names, titles, dates, etc., accurately given? I find
that the title of the work of Trnka de Kr'zowitz, which is given as "Com-
mentarius de diabete," is really "De diabete commentarius"; that
"Rollo. Cases of diabetes, etc., 1797," should be "Rollo. Two cases,"
etc., or else the date should be changed; that "Bennet (J. B.) 1801,"
should be spelled with two t's instead of one; that the paper of "Dupuy-
tren et Thenard," which is said to have been published in the Bulletin
de la Societe de medecine, 1806, was really published in the Journal
de medecine, chirurgie, pharmacie, etc., for that year, p. 83, and that
only an extract from it is given in the Bulletin de la Faculte de medecine
de Paris (etc.), which is what Jaccoud intended to refer to, but of which
he did not give the correct title; that the date of the dissertation of
Salomon, which he gives as 1809, is really 1808; that the article referred
to as by "Renaudin" in 1818, is by "Renauldin" in the volume of the
Dictionnaire des sciences medicales, dated 1814; that the dissertation

MEDICAL BIBLIOGRAPHY

157

given as by "Siegmeyer" is by "Siegmayer," and that the title of the
thesis of Dusseaux is "Sur le diabete," and not "Du diabete," as given.
Here, then, are at least eight errors on this page, comparatively trivial,
it is true, but of such a character as to make it doubtful whether
Professor Jaccoud had himself examined all of these books whose
titles he quotes.

Second, let us look at the completeness of the list. It gives five titles
of works on Diabetes published prior to 1800. If its compiler had con-
sulted the bibliography given at the end of the article by Renauldin,
above referred to, he would have found over thirty titles of works pub-
lished prior to 1800, which should have been included, and he would
also have found a large number in Ploucquet's work, which is one of
which no medical bibliographer should be ignorant.

Third, as to absence of duplication or redundancy. From this fault
Dr. Jaccoud's Bibliography is free, and it is one not likely to occur in a
list of general treatises. It is a very common one, however, in lists of
references to cases, and it is one which requires minute examination of
each case to avoid; many specimens of it will be found in those sections
of the Index Catalogue of your Washington library which refer to cases
of a given disease, injury or operation.

Fourth, we come to the form in which Dr. Jaccoud gives his references.
As regards the individual items, judged by the rules given above, this
form is very bad. The size of the books is not given, nor the volume of
the journal, nor the page. The various medical encyclopaedias are re-
ferred to as "the Dictionary in thirty volumes," "the Dictionary in
fifteen volumes," &s., and the number of the volume is given in only one
instance, and that for a German encyclopaedia. On the other hand, un-
necessary space is occupied by giving the titles of journals in full instead
of using well-recognized abbreviations. The classification adopted is
a very good one — it is into treatises on the general subject, on complica-
tion with gangrene, with disordered vision, etc., on pathological anatomy
and etiology, chemistry, theories and treatment.

Now, probably, this seems to you very petty criticism, and so it would
be if it were intended for criticism, which it is not. I simply wish to
call your attention to the fact that there is a systematic way of giving
bibliographical references with which medical writers should be familiar,
and incidentally to suggest that when one calls attention to his own
bibliographical work as being especially fine, it is a sort of challenge
which some carper and doubter is sure to take up sooner or later. Taking
all things into consideration, the best specimens of medical bibliograph-
ical work with which I am acquainted are those given by my colleague,
Dr. Woodward, in the medical volume of the second part of the

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Medical and Surgical History of the War; and the work of Petit presently
to be alluded to.

M. Richet concludes his article in the Revue Scientifique as follows:
"Perhaps it is unwise to attribute so much importance to bibliography.
Perhaps the turning over the pages of many books and the consulting
of many authors has a tendency to destroy orginality. But on the whole
I do not think so. Moreover, those who have the rare gift of scientific
originality are altogether excused. They are creators and have no
need of being erudite. Those who need to be such are those who are
neither discoverers nor inventors, and it appears to me that such are in
the majority." This does not fully accord with the opinions of Prof.
Verneuil, who in his preface to the treatise on gastrostomy, by L. H.
Petit (Paris, 1879), introduces the book with the statement that it is a
work of pure erudition, compiled by a bibliographer who never has
performed, and probably never will perform, the operation of which he
gives the history; and yet that he has contributed as much to its future
success as those who have devised or practised it. He says: "Scientific
progress is due to three things of equal importance, namely, erudition,
observation and experiment. There is a bibliographical method which is
distinct, independent, worthy of cultivation for its own sake, and in no
way inferior to its two rivals in the amount and value of the information
which it furnishes. . . . While erudition certainly creates nothing, it leads
to creation. To discountenance research in literature is like advising
travellers who visit regions not yet fully explored, to refrain from
making use of the maps prepared by their predecessors. The great ob-
jection to such work is the amount of time which it requires, if it is to
be done thoroughly and accurately. This time is, moreover, the greater
since each bibliophile must serve his apprenticeship almost alone, for
the bibliographical method has not been taught yet, nor have its rules
been laid down. Certainly no one can do such work for himself upon all
subjects. A lifetime would be insufficient to thus study the hundredth
part of pathology; but we may ask of those who cannot do such work,
that at least they shall not disdain those who labor at it. Certainly we
do not wish to depreciate either observation or experiment, but we
desire that erudition should be honored as it merits, and that bibliogra-
phical work should be recognized as of public utility. With us to call a
man erudite implies rather the idea of narrow specialization and pro-
fessional inaptitude."

I have quoted thus fully from Professor Verneuil's eulogium as giving
the views of a French master upon the state of French professional
opinion on this subject. With us I think the feeling is rather one of
undue, uncritical admiration of bibliographical matters than of con-

MEDICAL BIBLIOGRAPHY

159

tempt or dislike; but, until quite recently, American physicians had
not at their command the means of research in medical literature pos-
sessed by their transatlantic brethren, and even now the physicians of
large portions of the country find it very difficult to get access to the
original material of literary research.

The members of the Medico-Chirurgical Faculty of Maryland, and
especially those who reside in Baltimore, are more favorably situated
in this respect than their professional brethren elsewhere. Possibly this
may be news to some of you, and I had better explain. You are all aware
that your society has a library here in Baltimore, a library which con-
tains for the most part only old books, and is practically little used, ex-
cept by a very few persons, and of which it might, until within the
last few years, have been said that its strongest characteristic was its
feebleness, being, as a Kentuckian would say, "powerful weak." Re-
cently, however, by the exertions of a few members, and especially
through the energy and zeal of your librarian, Dr. Cordell, the collection
has been put in order and made accessible, a certain number of cur-
rent medical journals are regularly received, and other improvements
have been effected. Permit me, however, to suggest to you that one of
the most important uses to which you can put your library here is to so
arrange it that it may be the means of your getting the full benefit of
your other collection over in Washington, which you may consider as a
sort of branch library of the Faculty. You all know that what is called
the Library of the Surgeon-General's Office is a large and valuable one,
but probably you have not all fully realized that it is your library,
intended for your benefit and use, and that it is not a Bureau Library
intended only for the use of officials. Such, however, is the fact, and
therefore it comes within the limits of my subject to offer you some sug-
gestions as to how you can best use both of your libraries, and what
should be done to maintain and increase their completeness and useful-
ness.

First, then, your library in Baltimore should be made, and kept, as
complete as possible in the local medical history of the city and State. It
should contain every medical book, pamphlet, etc., published in or
relating to the State. The great majority of these will cost nothing but
watchfulness and prompt application for them at the time of publica-
tion, but if they be not then obtained, the acquisition soon becomes
difficult. You want every report of a hospital, asylum, or dispensary,
every announcement or catalogue of a medical school, every mortality
report, order or hand-bill issued by sanitary authorities for the State or
city, and, as far as possible, you want to obtain at least two copies of
each, one for the Baltimore and one for the Washington branch. It is a

160

JOHN SHAW BILLINGS

matter of interest, also, to keep in the library a scrap-book for local
newspaper cuttings of all matters of medical or sanitary interest which
should be promptly and systematically inserted. A small scrap-book, prop-
erly indexed, to certain newspaper medical advertisements, especially
those of the various quacks who infest this, as they do all other large
cities, will be found in years to come very interesting, and, it may be,
useful.

The limited amount of funds available for increasing your Baltimore
collection will naturally be for the most part applied to the purchase of
medical journals. The main thing which you have to do is to perfect
the system of care and storage of your books, in order that they may be
perfectly secure against, let us say, unauthorized borrowing. This is
necessary, not only to preserve your own books, but to make it possible
for the Washington library to loan freely to the Baltimore library. The
Washington collection is a reference, and not a circulating, library. It
does not as a rule lend books to individuals, although in the case of
modern books, which can be readily replaced, it will do so upon a
deposit sufficient to amply cover their value, its rules in this respect
being the same as those of the Library of Congress; but it will lend
freely to other libraries which are so constructed, located, and managed
that the books in them are secure from fire, theft, etc.

Now, suppose that a member of the Faculty desires to prepare a
somewhat elaborate article upon some medical subject for a society or
journal, and that for this purpose he wishes to compare his own ex-
perience and observations with those of others: how is he to proceed?
Before attempting to answer this, permit me to suggest one or two
things which he should not do. In the first place, he should not as the
first step write a note to the Washington librarian, somewhat as follows:

Dear Sir: — I am preparing a paper on fractures and wish to obtain
the bibliography of the subject. Can you favor me with a copy of all
the references which you have collected upon this head? I shall be happy
to pay the expense of the copy.

Very truly yours,

This will no doubt seem to some to be not an unreasonable request, and
/et it is one with which it is impossible to comply. The librarian is busy
.vith his current work — cataloguing, printing, furnishing books, etc. He
nas no clerical force available for making copies, and he cannot employ
an unskilled clerk and give him access to his manuscript cards. He can-
not himself spare much time to assort and arrange references for
these special demands. For a subject which has only half a dozen refer-
ences he can furnish them, he can verify a quotation, and is glad to

MEDICAL BIBLIOGRAPHY

161

furnish information which a brief examination of a few volumes will
provide. If the inquirer will visit Washington he can see and examine
the reference cards and make such notes as he desires, provided always
that this does not interfere with the catalogue work.

In the second place, the man who proposes to write a paper or a
book should not as a rule issue a circular informing the world at
large of his intention, and calling upon physicians generally to report to
him at once all cases which they may have had of the particular disease
or injury which he proposes to discuss. I say as a rule, for I admit that a
certain amount of interesting and useful information may be obtained
in this way when it is requested by one who is recognized as having
himself already contributed largely to our information on the matter in
hand, and who is therefore an authority on the subject who may be well
intrusted with the classifying, comparing and judging of the results of
the work of others. But when a comparatively unknown man makes such
a demand upon the profession at large, his success will probably be
small — and properly so. A man should show that he has some money
of his own before calling on the public to bank with him.

This is, however, a digression from medical bibliography, which seems
to be a subject with regard to which it is extraordinarily difficult to keep
to the point. To obtain as much as possible from a library you should
bring as much information there as you can, and have it in as clear
and definite a form as possible. Note upon a slip of paper the books
you wish to see, giving their titles concisely, but clearly, so that the
man who is to find the books will not have to waste ten minutes of his
time in deciphering your references. Consult the Index Catalogue so far
as published, the Index Medicus, and the bibliographies attached to the
articles in the modern French and German encyclopaedias, and it
will be strange if you can find no titles which will put you on the right
road. Remember that the Index Catalogue is not a bibliography. The
question is sometimes asked why an attempt, at least, was not made
to make it such. Why the comparatively few medical journals, etc., which
the library does not contain, could not have been found in other libraries
and indexed there, and in like manner the titles of books have been
taken from other catalogues and the whole combined into a huge
bibliography. It is said "You have got so much, it is a pity you cannot
give it all." I shall not detain you with the various reasons why this
could not be done with the means and opportunities we had. When
the Index Catalogue is finished, if Congress will provide the funds nec-
essary for the preparation of a supplement to contain the titles of all
medical books and papers which are not in the library, it would no
doubt be a very good thing; but, for the present, we must console our-

162

JOHN SHAW BILLINGS

selves with the reflection that when we look down a string of references in
the catalogue, we can at all events promptly verify all of them by
examining the books; whereas, when we have consulted a bibliography,
we have next the very serious task of discovering in what libraries and
collections the various books are to be found, and we are nearly sure to
be made unhappy by being unable to discover some of them anywhere.
The fact that those which we cannot find are probably worthless is small
consolation, for we want to determine that fact for ourselves. My experi-
ence is, that by the time one has examined all the books on a particular
subject, to which references are given in the Index Catalogue, and has
followed out the various clues given in these books to others not indexed
but which are in the collection, he is usually rather pleased than other-
wise that he knows of no more references and therefore does not feel
bound to consult them. A large number indeed of those who use the
library select only the most recent literature relating to the subject of
their studies, and, so long as they can get this, care little or nothing for
the historical side of the matter. Perhaps I may some day have occasion
to write about the uses and abuses of the Index Catalogue, in which
case the main point I shall insist on is that it is a tool which must be
used for a time before you can judge of its merits. It is by no means a
perfect work, and although as yet I have only discovered, or had
pointed out, some half dozen errors which are specially discreditable
as indications of ignorance on the part of its compiler, I am nevertheless
quite sure there must be a number of others, and I hope those who
discover them will point them out to me, although I cannot truly
say that I shall be happy to receive this information.

Having prepared the list of references to be consulted, which it will
be found most convenient to arrange on card slips of uniform size — that
of an ordinary postal card is very good — the next thing is to get the
books. It is best to go to Washington and visit the library in person,
when this is possible. If the list of the books which it is desired to con-
sult be sent to the librarian so that he can have it the day before the
visit, some time and confusion will be avoided, and the visitor will find
the books which he desires to see laid out ready for his examination. If,
however, it is impossible to visit Washington, the inquirer had best get
some library which has the means of safely caring for the books, and
will be responsible in case of loss or damage, to borrow the books for
him through its librarian, the borrower of course paying the expense of
transportation. Now, in order that the library of the Faculty may be able
to borrow freely from your Washington branch, it must be so managed
and arranged that the books in it will be perfectly secure against loss.
At present this is not the case, and one of your first cares should be to

MEDICAL BIBLIOGRAPHY

163

improve matters in this respect. Until this is done books can only be
obtained freely from the Library of the Surgeon-General's Office by the
Library of the Peabody Institute, or that of the Johns Hopkins Uni-
versity.

Permit me next to call your attention to the fact that it is a part of
your duty to see that your Washington library is made and kept as com-
plete as possible. In the first place it should have every new medical
book, journal, report, or thesis, in every language, as soon as possible
after its publication. You ought to be certain of finding in this, our
National medical collection, the latest literature upon any subject con-
nected with medicine, and everything noted in the Index Medicus
should be upon its shelves. Now, to effect this would require an appro-
priation of from seven to eight thousand dollars a year. The journals
and transactions relating to medicine and the allied sciences will alone
cost about $2500 per annum. In the second place, the deficiencies in
the library should be gradually supplied as opportunity offers. The
amount and character of these deficiencies are matters of some interest.
In order to obtain some data on this point I have compared the catalogue
of the Washington library with those of the two largest collections of
books in existence, viz. the British Museum of London, and the
Bibliotheque Nationale of Paris. Taking the fasciculi of the catalogue
printed by the British Museum in 1881-82, I find that on 1140 pages,
containing about 34,000 titles exclusive of cross references, there are the
titles of 657 books and 880 inaugural theses relating to medicine.
Comparing these with the corresponding portions of the Washington
catalogue it is found that the British Museum has 262 medical books,
372 medical theses and 118 different editions which are not in the
Surgeon-General's Library. On the other hand the Surgeon-General's
Library has 285 books, 342 theses and 88 different editions which are not
in the British Museum. There are common to both libraries 277 books
and 508 theses. The two libraries therefore appear to be nearly equal
as regards medical books. This is exclusive of medical journals, trans-
actions and reports, in which the Washington library is much the richer.
The tables, I and II, show in detail, by countries and periods, the differ-
ence between the two collections as regards medical books.

The catalogue of the medical section of the Bibliotheque Nationale
in Paris is arranged by subjects and not by authors, does not include
inaugural theses or dissertations, and was published in 1857-73; hence
it is not possible to make an exact comparison between it and the Index
Catalogue or that of the British Museum. But taking the general sub-
jects, anatomy, fevers, diseases of the eye, and cholera, I have prepared
a table showing the results of a comparison of the two catalogues, from

164

JOHN SHAW BILLINGS

Total

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Anatomy, Fevers
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Total
Cholera

Grand total

MEDICAL BIBLIOGRAPHY

165

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166

JOHN SHAW BILLINGS

which it appears that in the first three subjects named 199 books are
common to both, 416 are in the Washington collection only, and 483 in
the Paris collection only. On the subject of cholera (excluding treat-
ment) 194 books are common to both, 745 are in the Washington library
only, and 272 in the Paris library only. The books which the Paris library
has, and our own library has not, are for the most part old books dating
before 1800, or French books which have come to the library under the
law which requires one copy of every publication to be deposited there.
This law is not strictly obeyed, for we have in our library 79 French
works on cholera which are not in the Paris catalogue, but it is due to
this law that the medical section of the National library of France is
essentially French and not cosmopolitan.

As the result of these comparisons I think it is safe to conclude that
the Library of the Surgeon-General's Office in Washington not only con-
tains more medical literature than the British Museum or the National
library of France, but that it covers a wider field, represents better the
medical literature of the whole world, and is decidedly a better practical
reference and working collection for medical purposes than either of the
great libraries referred to. Each library is, as might be expected, richest
in the literature of its own country; but the French library is compara-
tively poor in English and German medical books, and has almost
nothing in American medical literature, while the English library is also
poor in American literature, and comparatively weak in German medi-
cine of the present century. Both of them are rich in the literature of
the fifteenth and sixteenth centuries, and have many editions of older
works of which the Washington library has only one or two. Both of
them have been in existence for over three hundred years, and have had
almost unlimited funds for the purchase of books. Why then is it that
they do not contain all medical books which have ever been printed; and
that your medical library in Washington, which is only about twenty
years old and has never had in any one year funds sufficient to purchase
more than two-thirds of the medical books printed in various parts of
the world during that same year, should already be equal if not superior
to them in practical value? It appears to me that it is very largely due to
the fact that while the Washington library is the National collection, it
has been kept separate from the general National library. The result
of this has been that the medical profession has taken much more inter-
est in it than they would do if, as is the case with the English and
French medical collections, it became merely a section of the National
library.

As a matter of fact, comparatively little use is made by medical writers
of the collection in the British Museum or the Bibliotheque Nationale.

MEDICAL BIBLIOGRAPHY

167

They consult, in preference, the special medical libraries in London and
Paris, which are under the direction of medical bibliographers, such as
the libraries of the Royal College of Surgeons, or of the Royal Medical
and Chirurgical Society, or those of the Faculty of Medicine, or of the
Academy of Medicine, of Paris. It is to such special libraries that phy-
sicians give their books and pamphlets; and the rapid growth of the
Washington library is largely due to this cause. There is pouring into it
i steady stream of literature the sources of which are by no means con-
ined to this country, although, of course, the largest part comes from
:he United States. Those who incline to pessimistic views of human
mature, and to attribute all the actions of men to selfish motives, would
not find their views confirmed by my experience. I could name a number
of gentlemen who take almost as much interest in the library as if it
were their own, and who are constantly on the lookout to supply its
deficiencies. Now, so long as the library can preserve and extend this
feeling of interest in its completeness, so long it is sure to grow in value
and usefulness, but if it be merged into a general National library this
interest will rapidly diminish. It is not to be expected that the manager
of a large miscellaneous library, if well fitted for his position by a knowl-
edge of general literature, should also be familiar with the various
departments of scientific literature; as the modern Greeks say, "two water-
melons cannot be carried under one arm," and no subordinate or as-
sistant will have the same stimulus to do good work that the man who is
responsible in the eyes of the public will have. I think therefore that you
will do well to see that a proper and commodious fire-proof building
is provided for your Washington collection, that it is not merged into the
Congressional Library, and that it is granted sufficient funds to enable it
to secure all new medical books as they are published, and gradually to
collect the best of the older literature.

It is supposed by some that this library receives a copy of every medical
book published in the United States. This is not the case. Under the
copyright law, two copies of every copyrighted medical book are de-
posited in the Library of Congress, but no copy comes to the Library of
the Surgeon-General's Office. It seems to me that the law should be so
amended as to make our library the place of deposit for one of the copy-
right copies, and this is a matter to which I invite your attention.

It may perhaps seem to some of you that this Washington library of
yours is not after all such an important matter as I make it out to be,
and it must be confessed that I am not an impartial judge; nevertheless
it does seem to me that the making and keeping this library complete
is one of the most valuable means of advancing medical science in this
country which at present is within our grasp, and that it is within our

168

JOHN SHAW BILLINGS

grasp if the medical profession of the country choose to exert their in-
fluence for the purpose.

It is also well to remember that the opportunity which is now pre-
sented for placing this matter on a proper and permanent basis will not
occur again. There are not two springs in the year, nor in the life of a
nation, and if the spring work is not done in time the fruits of summer
and autumn will be correspondingly deficient.

It is true that the successful practitioner is rarely a book-worm, but
it is also true that "improvements are made by those who know well the
old methods." The toast of the Pure Mathematical Society of England
as given by Sir James Paget, namely, "Prosperity to pure mathematics,
may it never be of use to any man," is one with which I have no special
sympathy, but in so far as it is a plea for amusement, and for mental
exercise without reference to pecuniary results, it applies to bibliomania
as well. I like to see on the doctor's shelves a little group of books such
as Sprengel's or Daremberg's or Haeser's Histories of Medicine, the letters
of Guy Patin, the Medical Portrait Gallery of Pettigrew, the works of
John Brown of Edinburgh, or a collection of pamphlets relating to local
medical history; and it certainly does not cause a lower estimate of his
ability as a practical physician and surgeon to know that he reads some-
thing else beside manuals and text-books.

I like the quaint, old-timy name which the physicians of this State
have preserved for their society, "The Medical and Chirurgical Faculty
of Maryland." Do you know why for the last three hundred years and
more physicians have been known as the Faculty? All universities, prop-
erly so called, have other faculties — Faculties of Arts, of Law, of The-
ology; but by the world at large, when one speaks of "the Faculty," he is
understood as referring only to the medical profession. You will re-
member that in the old University of Paris, where this special meaning
of the term originated, those who graduated as doctors graduated also as
teachers; in other words, the Faculty of Medicine in Paris was composed
of all the graduated doctors of medicine of the University. Now, as Dr.
Raynaud points out in his admirable little book, "Les medecins au temps
de Moliere" (which should be added to the list of books above mentioned),
the other Faculties of the University were composed purely and simply
of learned men, whose sole object and work was to teach. "The physi-
cians, on the contrary, formed both a corps for instruction and a body
exercising a liberal profession of which they had the monopoly, a profes-
sion lucrative and honored, accessible as a rule only to the upper middle
class and brought into continual relations with the public." It was
therefore the Faculty whose affairs were of the most interest to the
world at large, and it is for this reason, according to Raynaud, that in
the world of Paris and France it became known as the Faculty.

MEDICAL BIBLIOGRAPHY

169

As the Faculty of Maryland has preserved the name, let it also pre-
serve the best of the traditions, such as for example that the doctor
should be what his name implies, an educated gentleman. It is to be
hoped that the scheme of higher medical education which your Uni-
versity is about to organize will include instruction in bibliographical
and historical methods as well as in those of the laboratory and clinic.
If this be done, your Washington library will become a very important
aid to the University, and your Baltimore collection will also be more
used and require more looking after.

I have occupied more time than I had intended, and yet I have said
very little of what I had in my mind to say when I prepared that
memorandum which was mentioned at the commencement of this ad-
dress. I shall be quite satisfied, however, if I can arouse some interest
in providing proper means for good medico-bibliographical work for the
direct benefit of our teachers and writers, and through them for the
benefit of every one, not only in this country, but in the whole world;
and if the result shall prove to be that "Our University" and "Our
Library" have been both helpful to and helped by "Our Medical and
Chirurgical Faculty of Maryland."

Scientific Men and Their Duties

Mr. Chairman and Fellow-Members of the Philosophical Society:

The honor of the presidency of such a society as this — carrying with
it, as it does, the duty of giving at the close of the term of office an ad-
dress on some subject of general interest, has been aptly compared to
the little book mentioned in the Revelations of St. John — the little book
which was "sweet in the mouth but bitter in the belly." I can only thank
you for the honor, and ask your indulgence as to the somewhat dis-
cursive remarks which I am about to inflict upon you.

There is a Spanish proverb to the effect that no man can at the same
time ring the bell and walk in the procession. For a few moments to-
night I am to ring the bell, and being thus out of the procession I can
glance for a moment at that part of it which is nearest. At first sight it
does not appear to be a very homogeneous or well-ordered parade, for
the individual members seem to be scattering in every direction, and
even sometimes to be pulling in opposite ways; yet there is, after all, a
definite movement of the whole mass in the direction of what we call
progress. It is not this general movement that I shall speak of, but
rather of the tendencies of individuals or of certain classes; some of the
molecular movements, so to speak, which are not only curious and in-
teresting of themselves, but which have an important bearing upon the
mass, and some comprehension of which is necessary to a right under-
standing of the present condition and future prospects of science in this
country.

The part of the procession of which I speak is made up of that body
or class of men who are known to the public generally as "scientists,"
"scientific men," or "men of science." As commonly used, all these terms
have much the same significance; but there are, nevertheless, shades of
distinction between them, and in fact we need several other terms for
purposes of classification of the rather heterogeneous mass to which they
are applied. The word "scientist" is a coinage of the newspaper reporter,
and, as ordinarily used, is very comprehensive. Webster defines a scientist
as being "one learned in science, a savant" — that is, a wise man — and the
word is often used in this sense. But the suggestion which the word
conveys to my mind is rather that of one whom the public suppose to
be a wise man, whether he is so or not, of one who claims to be scientific.

The President's Address before the Philosophical Society of Washington, December
4, 1886. Bulletin of the Philosophical Society of Washington 9: xxxv-lvi (1886-7).

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SCIENTIFIC MEN AND THEIR DUTIES

171

I shall, therefore, use the term "scientist" in the broadest sense, as includ-
ing scientific men, whether they claim to be such or not, and those who
claim to be scientific men whether they are so or not.

By a scientific man I mean a man who uses scientific method in the work
to which he specially devotes himself; who possesses scientific knowledge,
— not in all departments, but in certain special fields. By scientific
knowledge we mean knowledge which is definite and which can be ac-
curately expressed. It is true that this can rarely be done completely, so
that each proposition shall precisely indicate its own conditions, but
this is the ideal at which we aim. There is no man now living who can
properly be termed a complete savant, or scientist, in Webster's sense
of the word. There are a few men who are not only thoroughly scientific
in their own special departments, but are also men possessed of much
knowledge upon other subjects and who habitually think scientifically
upon most matters to which they give consideration; but these men are
the first to admit the incompleteness and superficiality of the knowledge
of many subjects which they possess, and to embrace the opportunity
which such a society as this affords of meeting with students of other
branches and of making that specially advantageous exchange in which
each gives and receives, yet retains all that he had at first.

Almost all men suppose that they think scientifically upon all sub-
jects; but, as a matter of fact, the number of persons who are so free
from personal equation due to heredity, to early associations, to emo-
tions of various kinds, or to temporary disorder of the digestive or nerv-
ous machinery that their mental vision is at all times achromatic and
not astigmatic, is very small indeed.

Every educated, healthy man possesses some scientific knowledge, and
it is not possible to fix any single test or characteristic which will dis-
tinguish the scientific from the unscientific man. There are scientific
tailors, bankers, and politicians, as well as physicists, chemists, and bi-
ologists. Kant's rule, that in each special branch of knowledge the amount
of science, properly so called, is equal to the amount of mathematics it
contains, corresponds to the definition of pure science as including
mathematics and logic, and nothing else. It also corresponds to the
distinction which most persons, consciously or unconsciously, make be-
tween the so-called physical, and the natural or biological sciences. Most
of us, I presume, have for the higher mathematics, and for the astrono-
mers and physicists who use them, that profound respect which pertains
to comparative ignorance, and to a belief that capacity for the higher
branches of abstract analysis is a much rarer mental quality than are
those required for the average work of the naturalist. I do not, however,
propose to discuss the hierarchy of the sciences; and the term science

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is now so generally used in the sense of knowledge, more or less ac-
curate, of any subject, more especially in the relations of causes and
effects, that we must use the word in this sense, and leave to the future
the task of devising terms which will distinguish the sciences, properly
so called, from those branches of study and occupation of which the most
that can be said is that they have a scientific side. It is a sad thing that
words should thus become polarized and spoiled, but there seems to be
no way of preventing it.

In a general way we may say that a scientific man exercises the intel-
lectual more than the emotional faculties, and is governed by his reason
rather than by his feelings. He should be a man of both general and
special culture, who has a little accurate information on many subjects
and much accurate information on some one or two subjects, and who,
moreover, is aware of his own ignorance and is not ashamed to confess it.

We must admit that many persons who are known as scientists do not
correspond to this definition. Have you never heard, and perhaps as-
sented to, some such statements as these: "Smith is a scientist, but he
doesn't seem to have good, common sense," or "he is a scientific crank?"

The unscientific mind has been defined as one which "is willing to
accept and make statements of which it has no clear conceptions to
begin with, and of whose truth it is not assured. It is the state of mind
where opinions are given and accepted without ever being subjected to
rigid tests." Accepting this definition, and also the implied definition of a
scientific mind as being the reverse of this, let us for a moment depart
from the beaten track which presidential addresses usually follow, and
instead of proceeding at once to eulogize the scientific mind and to re-
capitulate the wonderful results it has produced, let us consider the un-
scientific mind a little, not in a spirit of lofty condescension and ill-
disguised contempt, but sympathetically, and from the best side that we
can find. As this is the kind of mind which most of us share with our
neighbors, to a greater or less degree, it may be as well not to take too
gloomy a view of it. In the first place, the men with unscientific minds
form the immense majority of the human race.

Our associations, habits, customs, laws, occupations, and pleasures are,
in the main, suited to these unscientific minds; whose enjoyment of
social intercourse, of the every-day occurrences of life, of fiction, of art,
poetry, and the drama is, perhaps, none the less because they give and
accept opinions without subjecting them to rigid tests. It is because there
are a goodly number of men who do this that the sermons of clergymen,
the advice of lawyers, and the prescriptions of physicians have a market
value. This unscientific public has its uses. We can at least claim that
we furnish the materials for the truly scientific mind to work with and

SCIENTIFIC MEN AND THEIR DUTIES

173

upon; it is out of this undifferentiated mass that the scientific mind sup-
poses itself to be developed by specialization, and from it that it obtains
the means of its own existence. The man with the unscientific mind,
who amuses himself with business enterprises, and who does not care in
the least about ohms or pangenesis, may, nevertheless, be a man who
does as much good in the world, is as valuable a citizen, and as pleasant
a companion as some of the men of scientific minds with whom we are
acquainted.

And in this connection I venture to express my sympathy for two
classes of men who have in all ages been generally condemned and
scorned by others, namely, rich men and those who want to be rich.

I do not know that they need the sympathy, for our wealthy citizens
appear to support with much equanimity the disapprobation with which
they are visited by lecturers and writers — a condemnation which seems
in all ages to have been bestowed on those who have by those who have
not.

So far as those who actually are rich are concerned, we may, I suppose,
admit that a few of them — those who furnish the money to endow uni-
versities and professorships, to build laboratories, or to furnish in other
ways the means of support to scientific men — are not wholly bad. Then,
also, it is not always a man's own fault that he is rich; even a scientist may
accidentally and against his will become rich.

As to those who are not rich, but who wish to be rich, whose chief
desire and object is to make money, either to avoid the necessity for
further labor, or to secure their wives and children from want, or for
the sake of power and desire to rule, I presume it is unsafe to try to offer
any apologies for their existence. But when it is claimed for any class of
men, scientists or others, that they do not want these things it is well to
remember the remarks made by old Sandy Mackay after he had heard
a sermon on universal brotherhood: "And so the deevil's dead. Puir auld
Nickie; and him so little appreciated, too. Every gowk laying his sins on
auld Nick's back. But I'd no bury him until he began to smell a wee
strong like. It's a grewsome thing is premature interment."

I have tried to indicate briefly the sense in which the terms "scientist"
and "scientific man" are to be used and understood, and you see it is
not an easy matter. The difficulty is less as regards the term "man of
science." By this expression we mean a man who belongs to science
peculiarly and especially, whose chief object in life is scientific investiga-
tion, whose thoughts and hopes and desires are mainly concentrated upon
his search for new knowledge, whose thirst for fresh and accurate in-
formation is constant and insatiable. These are the men who have most
advanced science, and whom we delight to honor, more especially in

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these later days, by glowing eulogiums of their zeal, energy, and disin-
terestedness.

The man of science, as defined by his eulogists, is the beau ideal of a
philosopher, a man whose life is dedicated to the advancement of knowl-
edge for its own sake, and not for the sake of money or fame, or of pro-
fessional position or advancement. He undertakes scientific investigations
exclusively or mainly because he loves the work itself, and not with any
reference to the probable utility of the results. Such men delight in
mental effort, or in the observation of natural phenomena, or in experi-
mental work, or in historical research, in giving play to their imagina-
tion, in framing hypotheses and then in endeavoring to verify or disprove
them, but always the main incentive is their own personal satisfac-
tion (with which may be mingled some desire for personal fame),
and not the pleasure or the good of others. Carried to an extreme, the
eulogy of such men and their work is expressed in the toast of the
Mathematical Society of England: "Pure mathematics; may it never be
of use to any man!" Now, it is one thing to seek one's own pleasure, and
quite another thing to pride one's self upon doing so. The men who do
their scientific work for the love of it do some of the best work, and, as a
rule, do not pride themselves on it, or feel or express contempt for those
who seek their pleasure and amusement in other directions. It is only
from a certain class of eulogists of pure science, so called, that we get
such specimens of scientific "dudeism" as the toast just quoted, opposed
to which may be cited the Arab saying that "A wise man without works
is like a cloud without water."

There are other men who devote themselves to scientific work, but
who prefer to seek information that may be useful; who try to advance
our knowledge of Nature's laws in order that man may know how to
adapt himself and his surroundings to those laws, and thus be healthier
and happier. They make investigations, like the men of pure science —
investigations in which they may or may not take pleasure, but which
they make, even if tedious and disagreeable, for the sake of solving some
problem of practical importance. These are the men who receive from
the public the most honor, for it is seen that their work benefits others.
After all, this is not peculiar to the votaries of science. In all countries
and all times, and among all sorts and conditions of men, it has al-
ways been agreed that the best life, that which most deserves praise, is
that which is devoted to the helping of others, which is unselfish, not
stained by envy or jealousy, and which has as its main pleasure and
spring of action the desire of making other lives more pleasant, of
bringing light into the dark places, of helping humanity.

But, on the other hand, the man who makes a profession of doing

SCIENTIFIC MEN AND THEIR DUTIES

175

this, and who makes a living by so doing, the professional philanthropist,
whether he be scientist or emotionalist, is by no means to be judged by
his own assertions. Some wise German long ago remarked that "Esel
singen schlecht, weil sie zu hoch anstimmen" — that is, "asses sing badly
because they pitch their voices too high," and it is a criticism which it is
well to bear in mind.

In one of the sermons of Kin O1 the preacher tells the story of a
powerful clam who laughed at the fears of other fish, saying that when
he shut himself up he felt no anxiety; but on trying this method on one
occasion when he again opened his shell he found himself in a fish-
monger's shop. And to rely on one's own talents, on the services one may
have rendered, on cleverness, judgments strength, or official position,
and to feel secure in these, is to court the fate of the clam.

There are not very many men of science, and there are no satisfactory
means of increasing the number; it is just as useless to exhort men to
love science, or to sneer at them because they do not, as it is to advise
them to be six feet three inches high or to condemn a man because his
hair is not red.

While the ideal man of science must have a "clear, cold, keen intellect,
as inevitable and as merciless in its conclusions as a logic engine," it
would seem that, in the opinion of some, his greatness and superiority
consists not so much in the amount of knowledge he possesses, or in
what he does with it, as in the intensity and purity of his desire for
knowledge.

This so-called thirst for knowledge must be closely analogous to an
instinctive desire for exercise of an organ or faculty, such as that which
leads a rat to gnaw, or a man of fine physique to delight in exercise. Such
instincts should not be neglected. If the rat does not gnaw, his teeth will
become inconvenient or injurious to himself, but it is not clear that he
deserves any special eulogium merely because he gnaws.

It will be observed that the definition of a scientific man or man of
science, says nothing about his manners or morals. We may infer that a
man devoted to science would have neither time nor inclination for
dissipation or vice; that he would be virtuous either because of being
passionless or because of his clear foresight of the consequences of yield-
ing to temptation.

My own experience, however, would indicate that either this inference
is not correct or that some supposed scientific men have been wrongly
classified as such. How far the possession of a scientific mind and of
scientific knowledge compensates, or atones for, ill-breeding or immoral-

1 Cornhill Magazine, August, 1869, p. 196.

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ity, for surliness, vanity, and petty jealousy, for neglect of wife or chil-
dren, for uncleanliness, physical and mental, is a question which can
only be answered in each individual case; but the mere fact that a man
desires knowledge for its own sake appears to me to have little to do
with such questions. I would prefer to know whether the man's knowl-
edge and work is of any use to his fellow-men, whether he is the cause of
some happiness in others which would not exist without him. And it may
be noted that while utility is of small account in the eyes of some eulo-
gist, of the man of science they almost invariably base their claims for
his honor and support upon his usefulness.

The precise limit beyond which a scientist should not make money
has not yet been precisely determined, but in this vicinity there are
some reasons for thinking that the maximum limit is about $5,000 per
annum. If there are any members of the Philosophical Society of Wash-
ington who are making more than this, or who, as the result of careful and
scientific introspection, discover in themselves the dawning of a desire
to make more than this, they may console themselves with the reflection
that the precise ethics and etiquette which should govern their action
under such painful circumstances have not yet been formulated. The
more they demonstrate their indifference to mere pecuniary considera-
tions the more creditable it is to them; so much all are agreed upon; but
this is nothing new, nor is it specially applicable to scientists. Yet while
each may and must settle such questions as regards himself for himself,
let him be very cautious and chary about trying to settle them for other
people. Denunciations of other men engaged in scientific pursuits on
the ground that their motives are not the proper ones are often based on
insufficient or inaccurate knowledge, and seldom, I think, do good.

This is a country and an age of hurry, and there seems to be a desire
to rush scientific work as well as other things. One might suppose, from
some of the literature on the subject, that the great object is to make
discoveries as fast as possible; to get all the mathematical problems
worked out; all the chemical combinations made; all the insects and
plants properly labeled; all the bones and muscles of every animal
figured and described. From the point of view of the man of science there
does not seem to be occasion for such haste. Suppose that every living
thing were known, figured, and described. Would the naturalist be any
happier? Those who wish to make use of the results of scientific investi-
gation of course desire to hasten the work, and when they furnish the
means we cannot object to their urgency. Moreover, there is certainly no
occasion to fear that our stock of that peculiar form of bliss known as
ignorance will be soon materially diminished.

From my individual point of view, one of the prominent features in

SCIENTIFIC MEN AND THEIR DUTIES

177

the scientific procession is that part of it which is connected with
Government work. Our Society brings together a large number oi
scientific men connected with the various Departments; some of them
original investigators; most of them men whose chief, though not only,
pleasure is study. A few of them have important administrative duties,
and are brought into close relations with the heads of Departments and
with Congress. Upon men in such positions a double demand is made,
and they are subject to criticism from two very different standpoints. On
the one hand are the scientists, calling for investigations which shall
increase knowledge without special reference to utility, and sometimes
asking that employment be given to a particular scientist on the ground
that the work to which he wishes to devote himself is of no known use,
and therefore will not support him. On the other hand is the demand
from the business men's point of view — that they shall show practical
results; that in demands for appropriations from the public funds they
shall demonstrate that the use to be made of such appropriations is for
the public good, and that their accounts shall show that the money has
been properly expended — "properly," not merely in the sense of usefully,
but also in the legal sense — in the sense which was meant by Congress
in granting the funds. Nay, more, they must consider not only the inten-
tions of Congress but the opinions of the accounting officers of the
Treasury, the comptroller and auditor, and their clerks, and not rely
solely on their own interpretation of the statutes, if they would work to
the best advantage, and not have life made a perpetual burden and
vexation of spirit.

There is a tendency on the part of business men and lawyers to the
belief that scientific men are not good organizers or administrators, and
should be kept in leading strings; that it is unwise to trust them with
the expenditure of, or the accounting for, money, and that the precise
direction in which they are to investigate should be pointed out to them.
In other words, that they should be made problem-solving machines as
far as possible.

When we reflect on the number of persons who, like Mark Twain's
cat, feel that they are "nearly lightning on superintending;" on the
desire for power and authority, which is almost universal, the tendency
to this opinion is not to be wondered at. Moreover, as regards the man
of science, there is some reason for it in the very terms by which he is
defined, the characteristics for which he is chiefly eulogized.

The typical man of science is, in fact, in many cases an abnormity,
just as a great poet, a great painter, or a great musician is apt to be, and
this not only in an unusual development of one part of the brain, but in
an inferior development in others. True, there are exceptions to this rule

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— great and illustrious exceptions; but I think we must admit that the
man of science often lacks tact, and is indifferent to and careless about
matters which do not concern his special work, and especially about
matters of accounts and pecuniary details. If such a man is at the head
of a bureau, whose work requires many subordinates and the disburse-
ment of large sums of money, he may consider the business management
of his office as a nuisance, and delegate as much of it as possible to some
subordinate official, who, after a time, becomes the real head and director
of the bureau. Evil results have, however, been very rare, and the recogni-
tion of the possibility of their occurrence is by no means an admission
that they are a necessity, and still less of the proposition that administra-
tive officers should not be scientific men.

I feel very sure that there are always available scientific men, thor-
oughly well informed in their several departments, who are also thor-
oughly good business men, and are as well qualified for administrative
work as any. When such men are really wanted they can always be
found, and, as a matter of fact, a goodly number of them have been
found, and are now in the Government service.

The head of a bureau has great responsibilities; and while his position
is, in many respects, a desirable one, it would not be eagerly sought for
by most scientific men if its duties were fully understood.

In the first place the bureau chief must give up a great part of his time
to routine hack work. During his business, or office, hours he can do
little else than this routine work, partly because of its amount, and
partly because of the frequent interruptions to which he is subjected.
His visitors are of all kinds and come from all sorts of motives — some
to pass away half an hour, some to get information, some seeking office.
It will not work well if he takes the ground that his time is too important
to be wasted on casual callers and refers them to some assistant.

In the second place he must, to a great extent at least, give up the
pleasure of personal investigation of questions that specially interest him,
and turn them over to others. It rarely happens that he can carry out
his own plans in his own way, and perhaps it is well that this should be
the case. The general character of his work is usually determined for
him either by his predecessors, or by Congress, or by the general con-
sensus of opinion of scientific men interested in the particular subject or
subjects to which it relates. This last has very properly much weight; in
fact, it has much more weight than one might suppose, if he judged from
some criticisms made upon the work of some of our bureaus whose work
is more or less scientific. In these criticisms it is urged that the work has
not been properly planned and correlated; that it should not be left within
the power of one man to say what should be done; that the plans for
work should be prepared by disinterested scientific men — as, for instance,

SCIENTIFIC MEN AND THEIR DUTIES

179

by a committee of the National Academy — and that the function of the
bureau official should be executive only.

I have seen a good deal of this kind of literature within the last ten or
twelve years, and some of the authors of it are very distinguished men in
scientific work; yet I venture to question the wisdom of such suggestions.
As a rule, the plans for any extended scientific work to be undertaken
by a Government department are the result of very extended consulta-
tions with specialists, and meet with the approval of the majority of
them. Were it otherwise the difficulties in obtaining regular annual
appropriations for such work would be great and cumulative, for in a
short time the disapproval of the majority of the scientific public would
make itself felt in Congress. It is true that the vis inertia of an estab-
lished bureau is very great. The heads of Departments change with each
new administration, but the heads of bureaus remain; and if an unfit
man succeeds in obtaining one of these positions, it is a matter of great
difficulty to displace him; but it seems to me to be wiser to direct the
main effort to getting right men in right places rather than to attempt
to elaborate a system which shall give good results with inferior men as
the executive agents, which attempt is a waste of energy.

You are all familiar with the results of the inquiry which has been
made by a Congressional committee into the organization and work of
certain bureaus which are especially connected with scientific interests,
and with the different opinions which this inquiry has brought out from
scientific men. I think that the conclusion of the majority of the com-
mittee, that the work is, on the whole, being well done, and that the
people are getting the worth of their money, is generally assented to.
True, some mistakes have been made, some force has been wasted, some
officials have not given satisfaction; but is it probable that any other
system would give so much better results that it is wise to run the risks of
change?

This question brings us to the only definite proposition which has
been made in the direction, namely, the proposed Department of Science,
to which all the bureaus whose work is mainly scientific, such as the
Coast Survey, the Geological Survey, the Signal Service, the Naval Ob-
servatory, etc., shall be transferred.

The arguments in favor of this are familiar to you, and, as regards
one or two of the bureaus, it is probable that the proposed change
would effect an improvement; but as to the desirability of centralization
and consolidation of scientific interests and scientific work into one de-
partment under a single head, I confess that I have serious doubts.

One of the strongest arguments in favor of such consolidation that 1
have seen is the address of the late president of the Chemical Society of
Washington, Professor Clarke, "On the Relations of the Government to

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Chemistry," delivered about a year ago. Professor Clarke advises the
creation of a large, completely-equipped laboratory, planned by chemists
and managed by chemists, in which all the chemical researches required
by any department of the Government shall be made, and the abandon-
ment of individual laboratories in the several bureaus on the ground that
these last are small, imperfectly equipped, and not properly specialized;
that each chemist in them has too broad a range of duty and receives too
small a salary to command the best professional ability. He would have
a national laboratory, in which one specialist shall deal only with metals,
another with food products, a third with drugs, etc., while over the
whole, directing and correlating their work, shall preside the ideal
chemist, the all-round man, recognized as the leader of the chemists of
the United States. And so should the country get better and cheaper
results. It is an enticing plan and one which might be extended to many
other fields of work. Granting the premises that we shall have the best
possible equipment, with the best possible man at the head of it, and a
sufficient corps of trained specialists, each of whom will contentedly do
his own work as directed and be satisfied, so that there shall be no
jealousies, or strikes, or boycotting, and we have made a long stride
toward Utopia. But before we centralize in this way we must settle the
question of classification. Just as in arranging a large library there are
many books which belong in several different sections, so it is in applied
science. Is it certain that the examination of food product or of drugs
should be made under the direction of the national chemist rather than
under that of the Departments which are most interested in the composi-
tion and quality of these articles? This does not seem to me to be a self-
evident proposition by any means.

The opinion of a scientific man as to whether the Government should
or should not undertake to carry out any particular branch of scientific
research and publish the results, whether it should attempt to do such
work through officers of the Army and Navy, or more or less exclusively
through persons specially employed for the purpose, whether the scien-
tific work shall be done under the direction of those who wish to use,
and care only for, the practical results, or whether the scientific man
shall himself be the administrative head and direct the manner in which
his results shall be applied; the opinion of a scientific man on such
points, I say, will differ according to the part he expects or desires to take
in the work, according to the nature of the work, according to whether
he is an Army or Navy officer or not, according to whether he takes more
pleasure in scientific investigations than in administrative problems and
so forth.

It is necessary, therefore, to apply a correction for personal equation
to each individual set of opinions before its true weight and value can

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181

be estimated, and, unfortunately, no general formula for this purpose
has yet been worked out.

I can only indicate my own opinions, which are those of an Army
officer, who has all he wants to do, who does not covet any of his
neighbors' work or goods, and who does not care to have any more
masters than those whom he is at present trying to serve. You see that I
give you some of the data for the formula by which you are to correct
my statements, but this is all I can do.

I am not inclined at present to urge the creation of a department of
science as an independent department of the Government having at its
head a Cabinet officer. Whether such an organization may become ex-
pedient in the future seems to me doubtful; but at all events I think the
time has not yet come for it.

I do not believe that Government should undertake scientific work
merely or mainly because it is scientific, or because some useful results
may possibly be obtained from it. It should do, or cause to be done,
such scientific work as is needful for its own information and guidance
when such work cannot be done, or cannot be done so cheaply or con-
veniently, by private enterprise. Some kinds of work it can best have
done by private contract, and not by officials; others, by its own officers.
To this last class belong those branches of scientific investigation, or the
means for promoting them, which require long-continued labor and
expenditure on a uniform plan — such as the work of the Government
Observatory, of the Government surveys, of the collection of the statistics
which are so much needed for legislative guidance, and in which we
are at present so deficient, the formation of museums and libraries, and
so forth.

Considering the plans and operations of these Government institutions
from the point of view of the scientific public, it is highly desirable that
they should contribute to the advancement of abstract science, as well
as to the special practical ends for which they have been instituted; but
from the point of view of the legislator, who has the responsibility of
granting the funds for their support, the practical results should receive
the chief consideration, and therefore they should be the chief considera-
tion on the part of those who are to administer these trusts. It must be
borne in mind that while the average legislator is, in many cases, not
qualified to judge a priori as to what practical results may be ex-
pected from a given plan for scientific work, he is, nevertheless, the
court which is to decide the question according to the best evidence which
he can get, or, rather, which is brought before him, and it is no unim-
portant part of the duty of those who are experts in these matters to
furnish such evidence.

But in saying that practical results should be the chief consideration of

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the Government and of its legislative and administrative agents it is not
meant that these should be the only considerations. In the carrying out
of any extensive piece of work which involves the collection of data,
experimental inquiry, or the application of scientific results under new
conditions there is more or less opportunity to increase knowledge at
the same time and with comparatively little increased cost. Such oppor-
tunity should be taken advantage of, and is also a proper subsidiary
reason for adopting one plan of work in preference to another, or for
selecting for appointment persons qualified not only to do the particular
work which is the main object, but also for other allied work of a more
purely scientific character.

On the same principle it seems to me proper and expedient that when
permanent Government employees have at times not enough to do in
their own departments, and can be usefully employed in scientific
work, it is quite legitimate and proper to thus make use of them. For
example, it is desirable that this country should have such an organiza-
tion of its Army and Navy as will permit of rapid expansion when the
necessity arises, and this requires that more officers shall be educated
and kept in the service than are needed for military and naval duty in
time of peace. It has been the policy of the Government to employ some
of these officers in work connected with other departments, and especially
in work which requires such special training, scientific or administrative,
or both, as such officers possess. To this objections are raised, which may
be summed up as follows:

First, that such officers ought not to be given positions which would
otherwise be filled by civilian scientists, because these places are more
needed by the civilians as a means of earning subsistence, and because
it tends to increase the competition for places and to lower salaries.
Put in other words, the argument is that it is injurious to the interests
of scientific men, taken as a body, that the Government should employ
in investigations or work requiring special knowledge and skill men
who have been educated and trained at its expense, and who are per-
manently employed and paid by it. This is analogous to the trades union
and the anti-convict labor platforms.

The second objection is that Army and Navy officers do not, as a rule,
possess the scientific and technical knowledge to properly perform duties
lying outside of the sphere of the work for which they have been edu-
cated, and that they employ as subordinates really skilled scientific men,
who make the plans and do most of the work, but do not receive proper
credit for it. The reply to this is that it is a question of fact in each par-
ticular case, and that if the officer is able to select and employ good men
to prepare the plans and to do the work, this in itself is a very good
reason for giving him the duty of such selection and employment.

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A third objection is that when an officer of the Army or Navy is de-
tailed for scientific or other special work the interests of this work and
of the public are too often made subordinate to the interests of the
naval or military service, more especially in the matter of change of
station. For example, civil engineers object to the policy of placing river
and harbor improvements in the hands of Army engineers, because one
of the objects kept in view by the War Department in making details
for this purpose is to vary the duty of the individual officer from time
to time so as to give him a wider experience. Hence it may happen that
an officer placed on duty in connection with the improvement of certain
harbors on the Great Lakes shall, after three or four years, and just as
he has gained sufficient experience of the peculiarities of lake work to
make his supervision there pecuiliarly valuable, be transferred to work
on the improvement of the Lower Mississippi with which he may be quite
unfamiliar.

In like manner Professor Clarke objects to having a laboratory con-
nected with the medical department of the Navy on the ground that
the officer in charge is changed every three years; consequently science
suffers in order that naval routine may be preserved.

There is force in this class of objections, but the moral I should draw
from them is, not that Army and Navy officers should not be allowed
to do work outside their own departments or in science, but that when
they are put upon such duty, the ordinary routine of change of station
every three or four years should not be enforced upon them without
careful consideration of the circumstances of the case, and satisfactory
evidence that the work on which they are engaged will not suffer by the
change. And, as a matter of fact, I believe this has been the policy
pursued, and instances could be given where an officer has been kept
twenty years at one station for this very reason.

I pass over a number of objections that I have heard made to the em-
ployment of Army and Navy officers as administrators, on the ground
that they are too "bumptious," or "domineering," or "supercilious," or
"finicky," because every one knows what these mean and their force.
An Army officer is not necessarily a polished gentleman; neither is a
civilian; and a good organizer and administrator, whether officer or civil-
ian, will at times, and especially to some people, appear arbitrary and
dictatorial.

There is another objection to special details of Army or Navy officers
for scientific duties which comes not so much from outside persons as from
the War Department and the officers themselves, and it is this: Among
such officers there are always a certain number who not only prefer special
details to routine duty, but who actively seek for such details, who are
perpetual candidates for them.

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The proportion of men whose ideas as to their own scientific acquire-
ments, merits, and claims to attention are excessive as compared with
the ideas of their acquaintances on the same points is not greater in the
Army than elsewhere, but when an Army officer is afflicted in this way
the attack is sometimes very severe, and the so-called influence which he
brings to bear may cause a good deal of annoyance to the Department,
even if it be not sufficient to obtain his ends. I have heard officers of high
rank, in a fit of impatience under such circumstances, express a most
hearty and emphatic wish that no special details were possible, so that
lobbying for them should be useless. This, however, seems to me to be
too heroic a remedy for the disease, which, after all, only produces com-
paratively trifling irritation and discomfort.

The same evil exists, to a much greater extent, in the civil branches
of the Government. Few persons can fully appreciate the loss of time,
the worry, and the annoyance to which the responsible heads of some of
our bureaus for scientific work are subjected through the desire of people
for official position and for maintenance by the Government. They have
to stand always at the bat and protect their wickets from the balls which
are bowled at them in every direction, even from behind by some of
their own subordinates.

It is true that a great majority of the balls go wide and cause little
trouble, and a majority of the bowlers soon get tired and leave the field,
but there are generally a few persistent ones who gradually acquire
no small degree of skill in discovering the weak or unguarded points, and
succeed in making things lively for a time. Considered from the point
of view of the public interests, such men are useful, for although they
cause some loss of valuable time, and occasionally do a little damage by
promoting hostile legislation, yet their criticisms are often worth taking
into account; they tend to prevent the machine from getting into a rut,
and they promote activity and attention to business on the part of ad-
ministrative chiefs. It is a saying among dog fanciers that a few fleas on
a dog are good for him rather than otherwise, as they compel him to
take some exercise under any circumstances.

At all events I think it very doubtful whether the jealousies and desire
for position for one's self or one's friends which exist under present cir-
cumstances would be materially diminished under any other form of
organization, even under a department of science.

Some conflict of interests now exists it is true; some work is duplicated;
but neither the conflict nor the duplication are necessarily wholly evil
in themselves, nor in so far as they are evil are they necessary parts of
the present system. This system is of the nature of a growth; it is organic
and not a mere pudding-stone aggregation of heterogeneous materials,

SCIENTIFIC MEN AND THEIR DUTIES

185

and the wise course is to correct improper bendings and twistings gradu-
ally, prune judiciously, and go slow in trying to secure radical changes
lest death or permanent deformity result.

It will be seen that in what I have said I have not attempted to eulo-
gize science or scientists in the abstract. I should be very sorry, how-
ever, to have given any one the impression that I think they should not
be eulogized. Having read a number of eloquent tributes to their im-
portance by way of inducing a proper frame of mind in which to prepare
this address, it is possible that I overdid it a little, and was in a sort of
reaction stage when I began to write. But the more I have thought on
the subject, and the more carefully I have sought to analyze the motives
and character of those of my acquaintances who are either engaged in
scientific work or who wish to be considered as so doing, and to com-
pare them with those who have no pretensions to science, and who make
none, the more I have been convinced that upon the whole the eulogium
is the proper thing to give, and that it is not wise to be critical as to the
true inwardness of all that we see or hear.

At least nine-tenths of the praises which have been heaped upon
scientific men as a body are thoroughly well deserved. Among them are
to be found a very large proportion of true gentlemen, larger, I think,
than is to be found in any other class of men — men characterized by
modesty, unselfishness, scrupulous honesty, and truthfulness, and by the
full performance of their family and social duties.

Even their foibles may be likable. A little vanity of thirst for publicity,
zeal in claiming priority of discovery, or undue wrath over the other
scientist's theory, does not and should not detract from the esteem in
which we hold them. A very good way of viewing characteristics which
we do not like is to bear in mind that different parts of the brain have
different functions; that all of them cannot act at once, and that their
tendencies are sometimes contradictory.

There are times when a scientific man does not think scientifically,
when he does not want to so think, and possibly when it is best that he
should not so think. There is wisdom in Sam. Lawson's remark that
"Folks that are always telling you what they don't believe are sort o'
stringy and dry. There ain't no 'sorption got out o' not believing
nothing." At one time the emotional, at another the intellectual, side of
the scientific man has the ascendency, and one must appeal from one
state to the other. Were scientific thinking rigorously carried out to
practical results in every-day life there would be some very remarkable
social changes, and perhaps some very disagreeable ones.

That scientific pursuits give great pleasure without reference to their
utility, or to the fame or profit to be derived from them; that they

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tend to make a man good company to himself and to bring him into
pleasant associations is certain; and that a man's own pleasure and
happiness are things to be sought for in his work and companionship is
also certain. If in this address I have ventured to hint that this may not
be the only, nor even the most important, object in life, that one may
be a scientific man, or even a man of science, and yet not be worthy of
special reverence; because he may be at the same time an intensely selfish
man, and even a vicious man, I hope that it is clearly understood that it
is with no intention of depreciating the glory of science or the honor
which is due to the large number of scientific gentlemen whom I see
around me.

A scientific gentleman — all praise to him who merits this title — it is
the blue ribbon of our day.

We live in a fortunate time and place; in the early manhood of a
mighty nation, and in its capital city, which every year makes more
beautiful, and richer in the treasures of science, literature, and art which
all the keels of the sea and the iron roads of the land are bringing to it.
Life implies death; growth presages decay; but we have good reasons
for hoping that for our country and our people the evil days are yet far
off. Yet we may not rest and eat lotus; we may not devote our lives to
our own pleasure, even though it be pleasure derived from scientific
investigation. No man lives for himself alone; the scientific man should
do so least of all. There never was a time when the world had more need
of him, and there never was a time when more care was needful lest his
torch should prove a firebrand and destroy more than it illuminates.

The old creeds are quivering; shifting; changing like the colored flames
on the surface of the Bessemer crucible. They are being analyzed, and
accounted for, and toned down, and explained, until many are doubting
whether there is any solid substratum beneath; but the instinct which
gave those creeds their influence is unchanged.

The religions and philosophies of the Orient seem to have little in
common with modern science. The sage of the east did not try to climb
the ladder of knowledge step by step. He sought a wisdom which he
supposed far superior to all knowledge of earthly phenomena obtainable
through the senses. The man of science of the west seeks knowledge by
gradual accumulation, striving by comparison and experiment to elimi-
nate the errors of individual observations, and doubting the possibility
of attaining wisdom in any other way. The knowledge which he has, or
seeks, is knowledge which may be acquired partly by individual effort
and partly by co-operation, which requires material resources for its
development, the search for which may be organized and pursued

SCIENTIFIC MEN AND THEIR DUTIES

187

through the help of others, which is analogous in some respects to
property which may be used for power or pleasure. The theologian and
the poet claim that there is a wisdom which is not acquired but attained
to, which cannot be communicated or received at pleasure, which comes
in a way vaguely expressed by the words intuition or inspiration, which
acts through and upon the emotional rather than the intellectual facul-
ties, and which, thus acting, is sometimes of irresistible power in exciting
and directing the actions of individuals and of communities.

The answer of the modern biologist to the old Hebrew question, viz.,
"Why are children born with their hands clenched while men die
with their hands wide open?" would not in the least resemble that given
by the Rabbis, yet this last it is well that the scientist should also re-
member: "Because on entering the world men would grasp everything,
but on leaving it all slips away." There exist in men certain mental
phenomena, the study of which is included in what is known as ethics,
and which are usually assumed to depend upon what is called moral
law. Whether there is such a law and whether, if it exists, it can be logi-
cally deduced from observed facts in nature or is only known as a special
revelation, are questions upon which scientific men in their present
stage of development are not agreed. There is not yet any satisfactory
scientific basis for what is recognized as sound ethics and morality
throughout the civilized world; these rest upon another foundation.

This procession, bearing its lights of all kinds, smoky torches, clear-
burning lamps, farthing rush-lights, and sputtering brimstone matches,
passes through the few centuries of which we have a record, illuminating
an area which varies, but which has been growing steadily larger. The
individual members of the procession come from, and pass into,
shadow and darkness, but the light of the stream remains. Yet it does
not seem so much darkness, an infinite night, whence we come and
whither we go, as a fog which at a little distance obscures or hides all
things, but which, nevertheless, gives the impression that there is light
beyond and above it. In this fog we are living and groping, stumbling
down blind alleys, only to find that there is no thoroughfare, getting
lost and circling about on our own tracks as on a jumbie prairie; but
slowly and irregularly we do seem to be getting on, and to be establish-
ing some points in the survey of the continent of our own ignorance.

In some directions the man of science claims to lead the way; in others
the artist, the poet, the devotee. Far reaching as the speculations of the
man of science may be, ranging from the constitution and nature of a
universal protyle, through the building of a universe to its resolution
again into primal matter or modes of motion, he can frame no hypothesis

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which shall explain consciousness, nor has he any data for a formula
which shall tell what becomes of the individual when he disappears in
the all-surrounding mist. Does he go on seeking and learning in other
ways or other worlds? The great mass of mankind think that they have
some information bearing on these questions; but, if so, it is a part of the
wisdom of the Orient, and not of the physical or natural science of the
Occident. Whether after death there shall come increase of knowledge,
with increase of desires and of means of satisfying them, or whether there
shall be freedom from all desire, and an end of coming and going, we
do not know; nor is there any reason to suppose that it is a part of the
plan of the universe that we should know. We do know that the great
majority of men think that there are such things as right and duty — God
and a future life — and that to each man there comes the opportunity of
doing something which he and others recognize to be his duty. The
scientific explanation of a part of the process by which this has been
brought about, as by natural selection, heredity, education, progressive
changes in this or that particular mass of brain matter, has not much
bearing on the practical question of "What to do about it?" But it does,
nevertheless, indicate that it is not a characteristic to be denounced, or
opposed, or neglected, since, even in the "struggle-for-existence" theory,
it has been, and still is, of immense importance in human social develop-
ment.

"Four men," says the Talmud, "entered Paradise. One beheld and
died. One beheld and lost his senses. One destroyed the young plants.
One only entered in peace and came out in peace." Many are the mystic
and cabalistic interpretations which have been given of this saying; and
if for "Paradise" we read the "world of knowledge" each of you can no
doubt best interpret the parable for himself. Speaking to a body of
scientific men, each of whom has, I hope, also certain unscientific beliefs,
desires, hopes, and longings, I will only say: "Be strong and of a good
courage." As scientific men, let us try to increase and diffuse knowledge;
as men and citizens, let us try to be useful; and, in each capacity, let us do
the work that comes to us honestly and thoroughly, and fear not the un-
known future.

When we examine that wonderful series of wave marks which we call
the spectrum we find, as we go downwards, that the vibrations become
slower, the dark bands wider, until as last we reach a point where there
seems to be no more movements; the blackness is continuous, the ray
seems dead. Yet within this year Langley has found that a very long
way lower down the pulsations again appear, and form, as it were, an-
other spectrum; they never really ceased, but only changed in rhythm,

SCIENTIFIC MEN AND THEIR DUTIES

189

requiring new apparatus or new senses to appreciate them. And it may
well be that our human life is only a kind of lower spectrum, and that,
beyond and above the broad black band which we call death, there are
other modes of impulses — another spectrum — which registers the cease-
less beats of waves from the great central fountain of force, the heart of
the universe, in modes of existence of which we can but dimly dream.

Medicine in the United States, and Its
Relations To Co-operative Investigation

(Excerpts)

There is a class of medical schools in the United States whose object
is to give the minimum amount of instruction which will enable a man
to commence the practice of medicine without much danger of making
such serious and glaring blunders as will be readily detected by the
public. There are other schools whose aim and object is to make fairly
well trained practitioners; the general character of the instruction given
in these being substantially the same as that given in your English hospital
medical schools. The results of such a three years' graded course of in-
struction in medicine as these schools furnish, depend upon the character
of the material upon which they work; that is to say, upon the general
preliminary education possessed by the student at the time of his ma-
triculation. This is evidently too often defective, and only a few schools
have thus far ventured to establish any standard of preliminary examina-
tion which at all approaches in its demands that which is required in
England.

The proverb that it does not pay to give a 5,000 dollar education to a
5 dollar boy is clearly of American origin, and sums up a great deal of
experience.

You have nineteen portals of entrance to the profession, and have not
found it easy to keep them all up to the standard. In America we have
over eighty gates, a number of turnstiles, and a good deal of the ground
is unenclosed common. Many of our physicians are more or less dis-
satisfied with this state of things, and with the results thereof; and every
year in some States efforts are made to secure legislation, which it is
supposed will protect the interests of the profession, though those who
advocate such legislation are usually prudent enough to claim as their
only motive a desire for the protection of the public.

Now, how does this free trade in medicine and the low standard of
qualification, or no standard at all, required by law, affect practitioners
as individuals? To answer this, we must divide the profession into sev-

The annual address in medicine delivered before the British Medical Association,
August 11, 1886. British Medical Journal 2: 299-307 (14 Aug 1886). Excerpts are from
pp. 300-3, 304, 304-5, 305, and 307.

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191

eral classes. In the first place, in all our cities, great and small, there is a
large class of physicians who are as well educated and as thoroughly
competent to practise their art, as can be found in the world. They have
studied both at home and abroad, have had extensive clinical training,
are always supplied with the latest and best medical literature and the
most improved instruments, and many of them are connected with hos-
pitals and medical schools. Among them are found the majority of our
writers and teachers, and the successful men are the survivors of a strug-
gle in which there has been keen and incessant competition. These
physicians, whose positions are fairly assured, and who, as a rule, have
all the practice they desire, are not usually active leaders in movements
to secure medical legislation, although they passively assent to such ef-
forts, or at least do not oppose them; and their names may sometimes be
found appended to memorials urging such legislation. They are clear-
headed, shrewd, "practical" men, who know that their business interests
are not specially injured by quacks and ignoramuses, rather the contrary
in fact, for they are called on to repair the damage done by the quack to
people who have more money than brains; and they are not inclined to
risk the fate of the Mexican donkey who died of congejos agenas, that is,
"of other people's troubles."

Then there is another large class of honest, hard-working practitioners,
who rely more on what they call experience and common sense than on
book learning. Many of these have obtained assured positions of respecta-
bility and usefulness, and are comparatively indifferent to medical legis-
lation so far as their own interests are concerned. Others, however, who
are not so successful, feel the competition of the local herb-doctor or of
the travelling quack more keenly, and have more decided views about
the importance of diplomas. Among these are the young men who have
not yet acquired local fame, and who are apt to become very indignant
over the doings of some charlatan in the neighbourhood, or of some
druggist who prescribes over his counter. These last are usually quite
clear in their minds that the State ought to interfere and prevent injury
to the health of the people.

I have known two unsuccessful physicians who finally abandoned prac-
tice, and who gave as a reason for their failure — one that "he did not
know enough" and the other that "he had not the manners and tact
which would inspire confidence in his patients;" but such frank-speaking
men are rare.

# # * *

The relations of the United States Government to medical education
and to the practice of medicine are indirect only, the regulation of these

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matters by law being part of the police power which, under the constitu-
tion, is reserved exclusively to the individual States. The United States
employs physicians in its Indian Department, in the Pension Department,
in the Marine Hospital Service, and in the medical departments of the
army and navy, and it has power to regulate the practice of medicine in
those territories which are not yet organised into States, and also in the
District of Columbia; but thus far it has made no use of such power. The
qualifications of physicians employed in the army and navy, and in the
Marine Hospital Service, are determined by examinations made by boards
of medical officers belonging to those services. The possession of a di-
ploma from a respectable medical college is a prerequisite for such ex-
amination, but beyond this it does not count; that is to say, the examina-
tion is the same for the holders of all diplomas, and covers all branches
of medicine. But while the relations of the general government to medi-
cal education are thus indirect, they have of late years become of very
considerable practical importance, and are now exerting much influence
upon medical investigations and literature. This is being effected by the
museums and libraries, which are now being formed under the auspices
of the government at Washington, and also, to some extent, by certain
special investigations undertaken by the government in the interests of
preventive medicine. Of these various agencies, one of the most important
is the library which has been formed at Washington, under the auspices
of the medical department of the army in connection with the Army
Medical Museum; both of these institutions being a part of the results of
the late civil war. The museum was at first formed to illustrate military
medicine and surgery, giving the results, primary and secondary, of in-
juries inflicted by modern weapons of warfare, and of the diseases of
armies in the field; in which direction the collection is unrivalled in
extent and completeness. Gradually its scope has been enlarged to in-
clude illustrations of anatomy, development, and all branches of pathol-
ogy and therapeutics, so that it is fast covering the whole field of medical
science. In like manner the library, which commenced in a collection
of those books relating solely or especially to military medicine and sur-
gery, which were required in the compilation of the Medical and Surgical
History of the War, has expanded into a great medical library, which is
now one of the best practical working collections of the kind in the
world. These collections, then, no longer appertain exclusively, or chiefly,
to the business of one department, but belong to the whole profession of
the United States as a body; and the department which has charge of
them is managing them from this point of view. The influence of the
library in stimulating research, and upon the quality of medical litera-
ture, is already very perceptible, and is destined to increase with ad-

MEDICINE IN THE UNITED STATES

193

vancing years. I think I may also venture to claim that the utility of these
collections, and especially of the library, is by no means confined to the
medical profession of the United States, for the catalogues and indices,
which are being issued in connection with them, are of service to medical
writers and teachers all over the world.

* # # #

As to the condition of medical science and art in America, it partakes
of the general progress, for the press now makes all discoveries the com-
mon property of the civilised world. The marked feature of the present
epoch is the recent advance in knowledge as to the relations between
micro-organisms and certain diseases, and the strong stimulus which this
has given to preventive medicine. Sanitation is becoming fashionable,
and if we may believe some of its votaries, it is a very simple matter to
prolong the average lifetime to the scriptural "three-score years and
ten." All that is necessary is that everything shall be clean, and every
person virtuous.

Having learned to distinguish those diseases which can be prevented
much more easily and certainly than they can be cured, we may turn
them over to the sanitarian, who has his own battles to fight with ig-
norance and prejudice. If he succeeds, and so far as he succeeds, he will
change, in certain respects, the work of the practitioner.

The lives which are saved from cholera and typhoid, from consump-
tion and diphtheria, and from the acute specific diseases, will, at last, be
weakened and destroyed in other ways. The work of the physician will
not be lessened by preventive medicine; it will simply be required more
for older persons, and for another class of diseases. As sanitarians must
depend upon practitioners for much of the information which is essential
for their work, it follows that if preventive medicine is to become a
working power, it will bring the mass of the profession into closer rela-
tions with the State than its members have held heretofore. What these
relations shall be is one of the most interesting, and, at the same time,
one of the most difficult, of the many problems with which we, or our
successors, must deal. I have referred to some experiments on this subject
which are now being tried in America, where it is much easier to make
such trials than it is in an older country hampered with vested interests.
Just at present, in this, as in a number of other things, our tendency is
toward centralisation, both in the several States and for the whole coun-
try, and it is not improbable that we may go far on this road in the fu-
ture.

# # # #

A marked feature of the present day, in medicine as in other things, is

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the tendency to specialisation in study and in practice. But this very
development of specialties, of increasing minuteness in the division of
labour, increases the necessity for co-operation, and, in fact, tends to
create what we may call the specialty of co-operation. Formerly, a rifle, or
a watch, was made by a single workman. No two instruments were ex-
actly alike, each piece had its own individuality and was not interchange-
able, and the cost of the whole was such as to put it beyond the reach of
the multitude. Now, the work on these things is greatly subdivided; one
man makes only one small wheel, or spring, or pinion, and another an-
other, each doing his work according to a uniform pattern, rapidly, per-
fectly, and at comparatively small cost.

But, in addition to the workmen who make the individual parts, it is
now necessary to have one person specially skilled in making drawings
and preparing patterns, another to assemble the completed parts, and a
third to test the whole after it has been put together. As the centrifugal
force increases, the centripetal power must also increase.

In one sense medicine, as we have it to-day, is the result of co-opera-
tion, not of deliberate centrally planned and direct co-operation, but of
natural selection from results produced by many men, often working at
cross purposes and, therefore, wasting much energy, but nevertheless
working, though blindly, to a common end. And it is safe to predict that
in the future much of the best work will be done in the same way, by
individual effort inspired by the love of science, by personal ambition,
etc. But the results obtained in this way come slowly, and some things
that we want can hardly be obtained by individual effort, even if we were
willing to wait; hence we must look to organisation for help.

This is an age of machinery, of exchanges, of corporations, for all these
correspond to one and the same fundamental idea. Men make machines
to do what the individual cannot do, and they make them not only of
brass and iron, but of men, for such an obvious source of power to the
man or men who can master the combination is not likely to be over-
looked. One result of such organisation is seen in our encyclopaedic
works on medicine, whether these be called dictionaries or handbooks;
another in the great medical journals; another in associations which seek
to wield political influence; another in the comparatively recent attempt
at collective investigation of disease. With these may be classed also the
attempts of government departments to make scientific investigations, to
form libraries and museums, to do things which require long continuity
of effort on a definite plan in order to produce the best results. And it is
by the combination of all these, with the efforts of individual workers,
that substantial advance and improvement are to be effected.

In this broader view of co-operation, it is interesting to consider those

MEDICINE IN THE UNITED STATES

195

fields of labour to which comparatively few physicians can devote them-
selves, because of want of time and opportunity, but whose proper work-
ing is, nevertheless, of the greatest importance to the practitioner.

One of these is experimental laboratory-work; and in this direction the
prospect of valuable contributions from America is now exceedingly good.
Some of the wisest of our most wealthy men have shown their apprecia-
tion of the responsibilities which riches entail on their possessors, by
seeking new channels through which to benefit their fellow-men. While
the old and well known methods of endowing hospitals and charitable
institutions are not neglected, there is apparent an increasing tendency
to endeavour to promote the advancement of knowledge, and especially
of such knowledge as tends to the mitigation of suffering and the im-
provement of the race, to furnish means for the investigation of disease,
to provide laboratories, and to endow medical schools, and thus place
them beyond the reach of the temptations and difficulties which must
always exist when such schools are dependent upon the fees of students,
and are, therefore, practically commercial manufacturing establishments.

As illustrations of this tendency, I may mention the bequest of
£1,400,000 by Johns Hopkins to endow, in the city of Baltimore, a uni-
versity and a hospital of which the medical department is to be a special
feature, to be provided with the best laboratory and other facilities for
original investigation as well as for teaching; the gift of Mr. Carnegie to
the Bellevue Hospital Medical School of New York, in the shape of a
well-equipped pathological laboratory; the presentation by Mr. Vander-
bilt, and members of his family, to the College of Physicians of New York,
of £200,000, to provide for that school new buildings and clinics having
the best means of teaching and research; and the endowment by an un-
known donor, of a laboratory for the University Medical College of New
York, with the sum of £20,000.

Last year, in his retiring address as President of the New York Academy
of Medicine, Dr. Fordyce Barker referred to this tendency to regard
wealth as a trust to be used for the benefit of humanity, and, after sketch-
ing the requirements of the Academy on a scale which would require an
endowment of at least a million of dollars, predicted that such an en-
dowment would be furnished by wealthy citizens of the city. I believe
that he was right, and that his prediction will become history.

As the class of men who have wealth, leisure, and knowledge becomes
greater, there comes an ever increasing demand, not only for the best
medical skill, for the most expert practitioner, but also for exhaustive
research in every direction which promises to furnish new means for the
prevention or relief of suffering, and for warding off, as long as possible,
the inevitable end; and hence there is little reason to doubt that the ex-

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JOHN SHAW BILLINGS

amples I have named will be followed by others in the near future. With
such opportunities, and under such conditions and influences, the stimu-
lus to the young and ambitious worker is strong; we have abundance of
material of this kind upon which the process of natural selection can
operate, and there is little reason to doubt that the result will be sub-
stantial and valuable contributions to physiology, pathology, and thera-
peutics.

I have spoken to little purpose if I have failed to show you that there is
a great deal of human nature in American physicians, and that it is a
kind of human nature with which you are tolerably familiar. It should
be so, for we are of the same race — a race which, perhaps, as Emerson
says, "sets a higher value on wealth, victory, and material superiority than
other men, has less tranquility, is less easily contented." Our ancestors
were restless, fighters, freebooters and from these ancestors we have the
common inheritance of energy of what we call "firmness", and our op-
ponents unreasonable, pigheaded, stubbornness; of liking to manage our
own affairs, and, at the same time, to exercise a little judicious supervi-
sion over those of our neighbours; of hatred of humbug and lying; and,
in spite of our discontent, of a firm belief that our wives and children,
habits, houses, modes of business, and of treating disease are, on the
whole, better than those of any other people under the sun.

Privately, and between ourselves, we grumble and declare that the
country and profession are going to the dogs — nay, we must do so, or we
should not be of true English blood; but there is no need for me to tell
you that these are only "growing pains," and not symptoms of progres-
sive ataxy.

While we must consider the difficulties in the way of the improvement
of the science and art of medicine, difficulties due to ignorance, to in-
dolence, to conflict of interests, and to the eternal fitness of things, the
existence of such difficulties is not a matter to be bemoaned and lamented
over. These obstacles are the spice of life, the incentives to action, the
source of some of the greatest pleasures which it is given to man to ex-
perience.

The child, spending a happy hour with its new puzzle, is a type of the
scientific investigator. The naturalist who objected to the statement that
this is a miserable world which it is well to be soon done with, on the
ground that there are still many species of rhizopods which he had not
examined and classified, is another type. On the ethical and sociological
side, the matter is summed up in Ruskin's aphorism, that "Fools were
made that wise men may take care of them."

MEDICINE IN THE UNITED STATES

197

It is surely not without cause that there has been given to us this rest-
less spirit of inquisitiveness, this desire to compass the heavens and the
earth, this raging infinite thirst for knowledge: it is the outcome of brain-
training and natural selection for thousands and tens of thousands of
years.

We are in a period of the world's history characterised by material
prosperity, by increase of populations, by tendencies to uniformity, to
the making of individuals of small account. According to the Swiss phi-
losopher, Alphonse de Candolle, this is to last a thousand years or so,
after which the pendulum will swing the other way, and there will follow
a long period of diminution and separation of peoples, and of decadence.

Against that decay of nations we know of but one remedy, and that is
increase of knowledge and of wisdom. And this increase must be in our
knowledge, in the world's wisdom, and not merely in that of John, of
Fritz, or Claude.

As each man has special opportunities and duties, if he can only recog-
nise them, so it is with guilds, with professions, and with nations.

I have tried to indicate to you some of these opportunities which are
presenting themselves to my colleagues, your brothers, in the lands be-
yond the sea, and I hope that I shall not be considered rash or vain-
glorious in saying that I believe they will so use those opportunities as to
return compound interest for what they have received from the store-
house of our common inheritance. Force changes form and place, the
stored energy of the soil of our plains and valleys has been coming here
in the form of meat and grain, has appeared in muscle and brain, and in
a hundred other shapes, but none has been destroyed; our loss has been
your gain, and in our turn we have received full and fair exchange.

It is our part now to remember that there are not two springs in the
year, there are not two periods of youth abounding in energy and desire,
or of manhood's strength and self-poise, in the life of any man or of any
nation, and for us, as for those who have been before us, the Kanuri
proverb holds true, "Kabu datsia, kargum bago" — The days being fin-
ished, there is no more medicine.

Methods of Research in Medical
Literature

When I promised to speak briefly at this meeting on medical bibliog-
raphy, it was not because I had anything new to say on this subject, but
because it seemed possible that a few remarks might start a discussion
by the medical writers and teachers of this Association as to the methods
which they have found useful, and as to what they think can and should
be done here to facilitate this kind of research. From the days of Galen
to the middle of the seventeenth century, bibliographical work was the
most important business of the medical teacher. The great majority of the
writers of the Middle Ages busied themselves, not so much with observa-
tion of facts, or with experimental inquiry, as with seeking to find out
what Hippocrates, Galen, Avicenna, and other old masters had said
about the matter. When the discovery was made that, in order to deter-
mine the precise anatomy of a part, the function of an organ, or the re-
sults produced by a disease, it was best to look for one's self, instead of
consulting the fathers, and when this discovery had become popularized,
bibliographical and historical research fell for a time into neglect. Within
the last fifty years, however, there has been a revival in interest in the
collection of medical libraries and in historical research, which last has
become a necessity in many cases, if one would avoid doing useless work.
Attempts to learn what has been done, or said, or thought, by our prede-
cessors are due to widely different needs, and may be pursued by widely
different methods.

As specimens of subjects with regard to which bibliographical work is
most frequently called for, I give the following:

(1) To gather and compare the records of all reported cases of par-
ticular forms of abnormity, disease, or injury. The rarer and more anoma-
lous the abnormity or the disease, the more important it is to find the
widely-scattered records.

(2) To obtain statistical data with regard to the circumstances affecting
the prevalence of a certain disease, the relative frequency of particular
symptoms, and the comparative merits of different modes of treatment,
or the results of special operations.

(3) To obtain information as to details of methods which have been
tried in experimental physiology, pathology, or pharmacology, and as to

Delivered before the Association of American Physicians, Washington, June 2, 1887.
Transactions of the Association of American Psysicians 2: 57-67 (1887).

198

METHODS OF RESEARCH

199

the results; in order to avoid waste of time in devising apparatus, or in
trying methods, which have been already found worthless, or to obtain
suggestions as to new modes of experimentation.

(4) To trace the origin and development of medical organization in a
particular city or country, or to gather materials for a biographical sketch
of some celebrated physician, or for the history of a medical society.

(5) To obtain data for a comparison of the laws and customs of differ-
ent countries affecting medical education, or the right to practice, or the
care of the insane, or public hygiene, etc.

In literary research for biographical purposes, or to trace the develop-
ment of theories or institutions, the work must be done mainly by the
writer himself; and, while at the commencement he may be greatly
helped by systematic works of medical bibliography, he will soon find
himself wandering off into all sorts of curious by-paths and out-of-the-way
corners, into which he is led by obeying the golden rule for this kind of
work, namely, to "verify your references." In the first book which he
consults he will probably find two or three references, which will indi-
cate to him as many different books or articles which he will wish to con-
sult. When he gets these, each of them will probably give a few more
references, to be hunted up in like manner.

Meantime, it will not be an unprecedented or very remarkable occur-
rence if, in the course of his reading, he stumbles over several interesting
points not precisely connected with his original quest, but still having
some relation to it, and which it seems a pity not to look up while he is
about it, so he makes note of these, and of the references connected with
them, and sends for a fresh lot of books. He finds, also, that some of his
quotations are erroneous, that "some one has blundered or plagiarized,"
and proceeds with a sense of refreshment and satisfaction to hunt down
the culprit. And so the work expands, for, as Teufelsdrockh remarks,
"any road will lead you to the end of the world." To those who like this
sort of literary work it has a great fascination, and there are few educated
men who do not enjoy a short hunt of this kind, if they have time and
facilities for it. From a strictly utilitarian and merely pecuniary point of
view, the results of such bibliographical excursions are not usually very
remunerative, but they afford capital mental exercise, and occasionally
result in the production of some really interesting and valuable additions
to medical literature.

Men engaged in this line of research do not usually, except just at first,
care much about subject catalogues or indexes. They know what books
they want to see, and the catalogue which interests them most frequently
is a catalogue of authors in alphabetical order. The questions which they
ask of the librarian are something like the following: Have you got such

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JOHN SHAW BILLINGS

a book in the library? Who is the author of a book having such
a title? John Smith published a book about such a date — what is its title?
I want to see all the books that Peter Brown wrote or edited. How many
editions were published of "Jones's Surgery," and what translations were
made of it? When did the Ohio Medical Repository begin and end, and
who were its editors? These are all simple questions, which almost any
physician can answer for himself by the aid of good, ordinary author-
catalogues.

If the question is as to a collection of laws regulating medical practice
in Brussels, or the number of supplements to the "Catalogue of the New
York Hospital," some physicians might be troubled a little to find the
desired information in an author catalogue, not knowing the rule that a
government or corporation is considered to be the author of its laws,
reports, etc., and that, therefore, Belgium is the author of the first book,
and the New York Hospital of the second.

But while a simple alphabetical catalogue of authors will serve many
purposes in bibliographical research, and is, perhaps, the one most used
by the librarian, there are many points on which it fails to give the de-
sired information, and for which bibliographical lists or subject-cata-
logues are desirable; and just here a few definitions may be useful. By a
bibliography I mean a list of titles of books, and of references to articles
or paragraphs which relate to the subject in hand. By a critical bibliog-
raphy I mean a list in which shall be indicated those books or articles
which are of real value, as containing some addition to knowledge. In
many, perhaps most, cases, such lists are best published in chronological
form, thus indicating the successive dates on which new information was
given; but, in making them, the use of separate slips or cards, arranged
in alphabetical order, is the most convenient. The more complete such
lists can be made, the more valuable they are, but often too much time
is wasted in attempts to make them absolutely perfect. The great thing
to be kept in view is to make them accurate as far as they go, and one of
the best means of doing this is to indicate distinctly for each title quoted
as to whether you yourself have or have not seen and examined the book.
It should be constantly borne in mind that the proper object in giving
bibliographical lists is not to impress the reader with the extent and
variety of the author's research, but to give him the means of verifying
the author's statements, and of pushing the research further. It is analo-
gous to giving details of methods used in an experiment in physiology.
Hence the references given should not be too condensed. They should be
so clear, that from them it shall be easy to find the books, and for this
reason I ask your attention to the desirability of using a uniform system
of abbreviations of titles of journals and transactions in referring to

METHODS OF RESEARCH

201

them, and venture to suggest that the set of such abbreviations given at
the beginning of Vol. VII of the Index Catalogue may be found useful
for this purpose.

I have elsewhere called attention to the essential differences between
medical bibliography, properly so called, and subject-catalogues of par-
ticular libraries. No matter how large and complete a medical library
may be, its subject-catalogue can never form anything like a satisfactory
medical bibliography; it only makes a good foundation for one.

On the other hand, when you wish to use bibliographical lists pre-
pared by others, you have usually much difficulty in finding some of the
books referred to, while the references which you do find in a subject-
catalogue of a given library, can at all events be verified by visiting that
library. The labor of preparing bibliographical lists, and of research,
after one has been furnished with such a list, is in many cases very con-
siderable, and such work can usually only be carried on to advantage in
a large library. As this is preeminently an age of division of labor, it is
natural to apply this principle also to bibliographical research. There
are many cases in which what may be called mechanical bibliography
and literary research may be used to excellent advantage, and the field
for this kind of work will expand in the future. It is especially applicable
in those cases, indicated in a preceding part of this paper, in which it is
desired to compare the records of cases and operations, and to prepare
statistics. It is often much better for the busy practitioner to have this
work done for him than to attempt to do it himself, and especially is this
the case if he does not easily read other languages besides his own. It is
true that by employing others to do such work, he loses both pleasure
and instruction, but the field of professional work and study is now so
wide that it is impossible for any one man to cover it all, and he must be
content with cooperative effort. It is also true that such work is not only
sometimes expensive, but that it is often difficult to tell beforehand what
it will cost. There are several physicians in Washington who are willing
to undertake work of this kind in the library of the Surgeon-General's
Office, for physicians at a distance who cannot conveniently visit this
city, and their charge for such work, hunting up references, making ab-
stracts, translations, etc., is one dollar per hour. You can readily see that
there can be no very definite relation between the time occupied and
results produced: a half-page abstract may require two hours to prepare,
or it may be done in ten minutes, and sometimes it may cost less to pur-
chase a pamphlet than to obtain an abstract of it in this way. Neverthe-
less the demand for this kind of work is steadily increasing, and a supply
will arise to meet the demand.

In order to obtain satisfactory results from bibliographical work done

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in this way it is necessary that the points to be looked up shall be stated
as concisely, and as precisely, as possible; in other words that the person
who requests the search shall know clearly what he wants. I have else-
where called attention to this by quoting the warning which is printed on
the title-page of the Washington City Directory, namely, "If you want
to find a name in this directory, you must know how to spell it," which
is the same as the old Latin proverb, "qui nihil affert, nihil refert." When
I receive a letter stating that the writer is about to prepare a paper for
his county medical society; that he has selected for his subject, tumors of
the liver, or locomotor ataxy, or the causes of insanity in modern times;
and that he would be glad to have as complete a list of references as possi-
ble to all articles, reports of cases, or statistics connected with these
subjects, — and that his paper must be prepared in two weeks, — I know of
course that what he wants is one of the recent encyclopaedias of medicine,
and advise accordingly. The problem is not always so simple, however,
and I must confess that I am sometimes very much puzzled as to what to
reply to some of the queries which I receive. Nevertheless, we are all
learning gradually how to use medical libraries, and in a few years more
I predict that the wonder will be how we ever got on without them.

I have here a few of the books which are most used in this library for
subject-references, a list of which is appended to this paper. I include in
this list the catalogues of certain libraries for reasons already given. For
other valuable works consult in the Index-Catalogue the headings, Bib-
liography Medical, Biography Medical, and Medicine, History of. With
regard to the Index-Catalogue of this library, with which you are all more
or less familiar, I may say that its most important defects are those of
omission, that is, the failure to give under subject-headings all the refer-
ences to books and articles actually in the library which really belong
there, and it requires a little practice to enable one to get the best results
from it.

There are many books and journal articles which different men would
classify under different heads, and in most cases when one consults the
index for a particular subject he finds more references than he cares to be
bothered with, although the list is almost always incomplete owing to the
fact that we have not yet obtained all the medical books which have been
printed. We are, however, making fair progress in this direction; I think
we now have over three-fourths of all medical books which have any spe-
cial value or interest, and at least two-thirds of all the medical literature
which has been printed.

In consulting the index on any given subject it will usually be found
possible to select from the rather formidably large mass of titles those
which are most likely to be of interest by giving a little attention to

METHODS OF RESEARCH

203

author's names, to the place and date of publication and to the number
of pages and plates, if it is a journal article. The cross-references should
be consulted, and under the headings to which these will guide you will
often be found new cross-references which should also be looked up.

Since the year 1800, about one-half of the medical literature which has
been published, consists of medical journals and transactions. Nine-
tenths of the demands made on this library are based on references to
this class of literature, and it is therefore of the greatest importance in
medical bibliography. The number of medical journals and transactions
now received by this library, excluding those devoted to pharmacy and
dentistry, is over seven hundred, and it has been steadily increasing for
the last five years.

If we take Ploucquet's Literatura medica digesta to be as complete an
index of the medical literature in existence at the beginning of this cen-
tury as the Index Catalogue is of the medical literature now in existence,
it is evident that the number of references has more than quadrupled
during the present century. Nine-tenths at least, of it, becomes worthless,
and of no interest within ten years after the date of its publication, and
much of it is so when it first appears. Of that which is really new and
good a large part is pretty promptly made use of by systematizers and
compilers, but there is also a considerable portion which we cannot use
in our present state of knowledge but which become valuable building
material hereafter. To get this roughly sorted out, classified and labelled,
so that it can be found when wanted, is the object of indexing; to bring
it into use is the object of bibliography.

One of the most useful pieces of work which could now be undertaken
for the benefit of medical writers and investigators would be the prepara-
tion of a dictionary of critical bibliography of medical bibliography, in
which should be indicated for each subject in alphabetical order a refer-
ence to where the best bibliography relating to that subject can be found.
This could only be well done by a cooperation of a number of writers,
each taking a special field.

I have not attempted in this brief paper to eulogize bibliography or to
comment on the desirability that there should always be a few men in-
terested in the study of the history and literature of medicine. I think
that you will all agree with me that they may be sources of much pleasure,
and that this alone is a fairly good reason for giving them some attention,
and for exerting the influence of the profession to make it possible in at
least one place in this country to carry out such studies with a full supply
of material.

And while the librarian is in one respect only a sort of hod-carrier, who
brings together the bricks made by one set of men in order that another

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JOHN SHAW BILLINGS

set of men may build therewith — he is apt to take quite as much pride
and satisfaction in the resulting structure, provided it be a good one, as
if he had built it himself; and he has constantly unrolling before him a
panorama which, though at times a little monotonous, contains as much
wisdom, humor, and pathos, as any other product of the human intellect
with which I am acquainted.

List of Books Most Useful for Reference

Haller (Albertus). Bibliotheca botanica, qua scripta ad rem herbariam facientia a

rerum initiis recensentur. 2 v. 4°. Figuri, apud Orell, Gessner, Fuessli, et soc, 1751.
Heffter (Joh. Carolus). Museum disputatorium physico-medicum tripartitum. Ed. nova.

4 pts in 2 v. 4°. Zittaviae Lusatorum, sumt. Schoepsianis, 1763-4.
Haller (Albertus). Bibliotheca chirurgica, qua scripta ad artem chirurgicam facientia

a rerum initiis recensentur. 2 v. 8°. Bernae et Basileae, Haller et Schweighauscr,

1774-5.

Haller (Albertus). Bibliotheca anatomica qua scripta ad anatomen et physiologiam
facientia a rerum initiis recensentur. 2 v. 4°. Figuri, apud Orell, Gessner, Fuessli
et soc. 1774-7.

Haller (Albertus). Bibliotheca medicinae practicae qua scripta ad partem medicinae
practicam facientia a rerum initiis ad a. 1775 recensentur. 4 v. 4°. Basileae, Joh.
Schweighauser; Bernae, apud Em. Haller, 1776-8. Tome IV. Ex ejus schedis
restituit auxit et edidit Joachim Diterich Brandis ab anno 1686 ad a. 1707.

de Ploucquet (Guilielmus Godofredus). Literatura medica digesta sive repertorium
medicinae practicae, chirurgiae atque rei obstetriciae. 4 v. in 2. 4°. Tubingae,
J. G. Cotta, 1808-9.

Watt (Robert). Bibliotheca Britannica; or a general index to British and foreign litera-
ture. 4 v. 4°. Edinburgh, A. Constable & Co., 1824.

Jourdan (A. J. L) Dictionnaire des sciences medicales. Biographie medicale. 7 v. 8°.
Paris, Panckoucke, 1820-25.

Dezeimeris (J. E.) Ollivier et Raige-Delorme. Dictionnaire historique de la medicine
ancienne et moderne, ou precis de l'histoire generate, technologique et litteraire
de la medicine, suivi de la bibliographic medicale de dix-neuvieme siecle, et
d'un repertoire bibliographique par ordre de matieres. 4 v. in 7. 8°. Paris, Bechet
jcune, 1828-39.

a Roy (Cornelius Henricus). Catalogus bibliothecae medicae. 5 v. 8°. Amstelodami, L.
van Es, 1830.

Forbes (John). A manual of select medical bibliography in which the books are ar-
ranged chronologically according to the subjects, etc. 8°. London, Sherwood,
Gilbert & Piper, 1835.

Callisen (A. C. P.) Medicinisches Schriftsteller-Lexicon der jetzt lebenden Aerzte,
Wundarzte, Geburtshulfer, Apotheker und Naturforscher aller gebildeten Volker.
33 v. 8°. Copenhagen u. Altona, 1830-45.

Choulant (Ludwig). Handbuch der Bucherkunde fur die altere Medicin zur Kenntniss
der griechischen, lateinischen und arabischen Schriften im arztlichen Fache und
zur bibliographischen Unterscheidung ihrer verscheidenen Ausgaben, Ueber-
setzungen und Erlauterungen. 2. aufl. 8°. Leipzig, L. Voss, 1841.

Bibliotheca medico-historica sive catalogus librorum historicorum de re medica et
scientia naturali systematicus. 8°. Lipsiae, sumpt. G. Engelmann, 1842.

Holtrop (Leonardus Stephanus Augustus). Bibliotheca medico-chirurgica et pharma-

METHODS OF RESEARCH

205

ceutico-chemica, sive catalogus alphabeticus omnium librorum, dissertationum,
etc., ad anatomiam, artem medicam chirurgicam, obstetriciam, pharmaceuticam,
chemicam, botanicam, physico-medicam et veterinariam pertinentium, et in Belgio
ab anno 1790, ad annum 1840 editoram. Hagae-Comitis. C. Fuhr, 1842.

Royal College of Surgeons in London. A classed catalogue of the books contained in the
library of the, 8°. London, J. Scott, 1843.

Jahrbiicher der in und auslandischen gesammten Medicin. v. 1-40, 1834-43. roy. 8°.
Leipzig, O. Wigand. Continued as: Schmidt's Jahrbiicher. v. 41-213, 1844-87. roy.
8°. Leipzig.

Bibliotheca medico-chirurgica pharmaceutico-chemica et veterinaria oder geordnete
Uebersicht aller in Deutschland neu erchienenen medicinisch-chirurgisch-geburts-
hiilflichen pharmaceutisch-chemischen und veterinar-wissenschaftlichen Biicher.
8°. Gottingen, 1847-86.

Engelmann (W.) Bibliotheca medico-chirurgica et anatomico-physiologica. Alpha-
betisches Verzeichniss der medicinischen, chirurgischen, geburtshiilflichen, ana-
tomischen und physiologischen Biicher, welche vom Jahre 1750 bis zu Ende des
Jahres 1867 in Deutschland erschienen sind. 2 v. 8°. Leipzig, W. Engelmann, 1848-
68.

Fischer, (Emil). Catalogue raisonne of the Medical Library of the Pennsylvania Hospital.

8°. Philadelphia, T. K. 8c P. G. Collins, 1857.
Bibliotheque nationale. Department des imprimes. Catalogue des sciences medicales.

2 v. 4°. Paris, Didot freres, 1857, 1873.
Dictionnaire encyclopedique des sciences medicales. Directeur: A. Dechambre. Col-

laborateurs: MM. les docteurs Archambault, Arnould (J), Axenfeld, Baillarger

[et al.] 1 s., v. 1-34; 2. s., v. 1-22; 3. s., v. 1-16; 4. s., v. 1-12; 5. s., v. 1. Paris, 1864-

87.

Royal Society of London. Catalogue of scientific papers compiled and published by the,
8 v. 8°. London, G. E. Eyre & W. Spottiswoode, 1867-79.

Catalogue of the Library of the Royal College of Physicians of Edinburgh. 4°. Edin-
burgh, R. and R. Clark. 1863. Supplement, 1863-70. 4°. Edinburgh, Crawford and
McCabe, 1870.

Nouveau dictionnaire de medicine et de chirurgie pratique. Redige par Anger, Bailly
[et al.] Directeur de la redaction, le docteur Jaccoud. 40 v. and suppl. 8°. Paris,
1864-86.

Jahresbericht iiber die Leistungen und Fortschritte der gesammten Medicin (Fortset-
zung von Canstatt's Jahresbericht). Unter Mitwirkung zahlreicher Gelehrten
hrsg. von Rud. Virchow und Aug. Hirsch. Jahrg. 1-20, 1866-85. 39 v. 8°. Berlin A.
Hirschwald, 1867-86.

Manchester Medical Society. Alphabetical Catalogue of the Library of the, 8°. Man-
chester, W. Alcock, 1866. Supplementary Catalogue of the Library of, 8°. Man-
chester, W. Alcock, 1872.

Papily (Alphonse). Bibliographic des sciences medicales: bibliographic biographie,
histoire, epidemies, topographies, endemies. 8°. Paris, Tross, 187[2-]4.

Jahresbericht iiber die Leistungen und Fortschritte in der Anatomie und Physiologic
10 v. 8°. Berlin, A. Hirschwald, 1874-85.

Waring (Edward John). Bibliotheca therapeutica, or bibliography of therapeutics,
chiefly in reference to articles of the materia medica, with numerous critical, his-
torical and therapeutical annotations, and an appendix containing the bibliography
of British mineral waters. 2 v. 8°. London, New Sydenham Soc, 1878.

Haeser (Heinrich). Lehrbuch der Geschichte der Medicin und der epidemischen
Krankheiten. 3. Aufl. 3 v. 8°. Jena, H. Dufft, 1875-82.

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JOHN SHAW BILLINGS

Royal Medical and Chirurgical Society of London. Catalogue of the Library of the,
3 v. 8°. London, 1879.

Index Medicus. A monthly classified record of the current medical literature of the

world, v. 1-9. 8°. New York, Boston, Mass., and Detroit, Mich., 1879-87.
Bibliotheca medica Davidsoniana. Catalogue de la bibliotheque precieuse medicale de

feu. M. le docteur Davidson. 8°. Breslau, G. Paetz, 1880.
United States. War Department. Surgeon-General's Office. Index-Catalogue of the

Library of the Surgeon-General's Office, United States Army. I-VIII. A-Medicine

(Naval) 8 v. roy. 8°. Washington, 1880-87.
Neale (Richard). The medical digest, or busy practitioner's vade-mecum. Being a

means of readily acquiring information upon the principal contributions to

medical science during the last thirty-five years. 2 ed. 8°. London, Ledger, Smith

& Co., 1882.

Hirsch (A.) Biographisches Lexikon der hervorragenden Aerzte aller zeiten und Volker.

Unter Mitwirkung der Herren A. Anagnostakis. E. Albert [et al.] und unter

Special-Redaction von A. Wernich, und E. Gurlt. 8°. Wien u. Leipzig. Urban 8c

Schwarzenberg, 1884-87.
Faculty of Physicians and Surgeons of Glasgow. Alphabetical catalogue of the Library

of the . . . 4°. Glasgow, R. Maclehose, 1885.
Neale (Richard). The first appendix to the medical digest, including the years 1882—

3-4-5, and early part of 1886. 8°. London, Ledger, Smith 8c Co., 1886.

Hollerith Cards

For all cities having a population of 200,000 and upwards, and for all
states which have a registration of deaths sufficiently complete to make it
worth while to compile the statistics, I recommend that the data for each
individual death be recorded, as fast as reported, upon cards by punching
out holes. Several members of this Association have seen the system of
cards, and the machine for counting any desired combination of data
from these cards, which has been devised by Mr. Herman Hollerith, and
which is now in Washington. It is comparatively simple, not liable to get
out of order, and does its work rapidly and accurately. I have watched
with great interest the progress in developing and perfecting this ma-
chine, because seven years ago I became satisfied that some such system
was possible and desirable, and advised Mr. Hollerith, who was then en-
gaged on census work, to take the matter up and devise such a machine
as is needed for counting various combinations of large numbers of data,
as in census work or in vital statistics. I think that he has succeeded, and
that the compilers of demographical data will be glad to know of this
system.

Excerpted from "On some forms of tables of vital statistics, with special reference to
the needs of the health department of a city." Pp. 204-5 of Public Health Papers and
Reports, American Public Health Association 13: 203-23 (1887).

207

Ideals of Medical Education

When the medical faculty of an ancient, famous, and progressive uni-
versity honors a physician by the request that he will deliver an address
to it, and to its friends, upon such an occasion as this, the subject of that
address must be sought within certain limits. It should have some rela-
tion to the special work of the Faculty — to medical education as it was,
or is, or should be. The fact that you have already had three addresses
bearing on this subject by distinguished medical teachers, who are more
familiar with its practical bearings and needs than I can be, does not
authorize me to try another field, although it greatly increases my diffi-
culty in selecting reflections and suggestions which are suited to the oc-
casion and to the audience, and which, at the same time, will not be a
wearisome repetition of what is already familiar to you. I know, how-
ever, that discourses of this kind are soon forgotten; were it otherwise, this
would indeed be a hard world for address givers.

Of course the Medical Department of Yale is organized in the best
possible manner, and is doing the best possible work, — under the circum-
stances. I do not know precisely what its organization is, or what work it
is doing, or the exact circumstances which govern it, but I have no
doubt it is safe to assume this. There is one circumstance, however,
which very commonly affects medical schools and universities — and
which, therefore, may possibly affect you — and that is the want of means
to do everything that anybody may consider desirable. Perhaps, then, some
remarks upon certain modern ideals of medical education, and upon
first class medical schools and their cost based upon data derived from
other schools, may be of some interest — especially in the light of Roche-
foucauld's aphorism that there is something in the misfortunes of our
best friends which is not displeasing to us.

The great mass of the public — the majority of the voters of all parties,
and of the women who are not voters, know little and care less about
the details of professional education, or about the standard of qualifica-
tion attained to by those to whom they entrust more or less of the care
of their souls, their property, or their bodies. The popular feeling is,
that in a free country every one should have the right to follow any
occupation he likes, and employ for any purpose any one whom he
selects, and that each party must take the consequences.

It is noteworthy, however, that each individual professing to hold this

Address delivered before the Medical Faculty of Yale University, June 23, 1891.
Boston Medical and Surgical Journal 124: 619-23; 125: 1-4 (1891).

208

IDEALS OF MEDICAL EDUCATION

209

opinion, almost always makes an exception as to his own occupation if
it is one involving skilled labor, — he is in favor of free trade in the ab-
stract— and of limitations with regards to his own particular trade, either
as to number of apprentices, as to time of study, or as to some form of
trust which will, as far as possible, prevent competition in that special
business. In one of its aspects, medicine is a trade, carried on for
the purpose of making money in order to support the physician and his
family, and to the majority of practitioners this is a very important aspect,
although to very few of them is it the only one. Hence it is that medical
faculties must consider schemes of medical education from this point of
view also, not exclusively so by any means, but, nevertheless, with refer-
ence to the questions — what do we propose to offer? — how much will it
cost us? — how much shall we charge for it? With reference to the first
question, it is obvious that there are several quite different kinds of
education which a medical faculty may offer to its students. It is by no
means easy to decide as to the quality and quantity of the article offered
by consulting only the advertisements, circulars, and prospectuses of the
hundred and more medical schools in the United States, but even
from these it can be seen that one can get a diploma of Doctor of Medi-
cine in much less time, and at much less expense, from some schools than
from others, and we all know that the diplomas of these different schools
are guarantees of very different education and qualifications.

There are also several different ideals as to what is desirable in medical
education. For instance, there is the ideal of the literary man, of the
clergyman — of the laborer, and of other classes of the general public.
There is the ideal of the man who wants to obtain a medical degree as
soon and as cheaply as possible in order that he may commence prac-
tice; the ideal of the same man after he has obtained such a degree and
has been for two or three years trying to get practice; and the ideal of the
middle aged successful practitioner who has learned several things by
experience since he graduated. Then we have the ideal of the Army and
Navy Examining Boards; the ideal of the man of means who wants to
become a specialist without ever going into general practice — and the
ideal of the man who wishes to be an investigator and a teacher
either from the love of science or from the desire for fame. Let us con-
sider some of these ideals briefly. The chief demand of the great mass of
the non-professional public is for general practitioners, — and the quali-
fications which these should possess may be summed up in the statement
that they should be competent to recognize the forms of disease and in-
jury which are common in the community in which they practice, — and
should know, and be able to apply, the remedies which are most fre-
quently used and found efficacious in such cases. They are expected, for

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JOHN SHAW BILLINGS

the most part, to follow and not to lead — it is not necessary that they
should be skilled in the refinements of modern pathology — or be thor-
oughly trained in minute anatomy or experimental physiology, or be
great surgeons, or be well up in all the specialties. Observe that I say
it is not necessary — it may be desirable, but in the majority of cases it
is not practicable.

In their brief journey of life through this world, the great majority
of people must travel on the routes and by the vehicles provided for
them by others, and, fortunately, they are usually content to do so. They
move in groups which are "personally conducted," see the things they
are told to see, try, with more or less success, to admire the things
which they are told to admire, and their chief discomfort occurs when
their conductors are either silent, or give contradictory orders, when it
comes to the parting of the ways. Most travelers on an Atlantic steamer
accept without murmuring the edict that "Passengers are not allowed on
the bridge."

The information which those who propose to earn their living by the
general practice of medicine stand most in need of, is that which will
enable them to recognize the ordinary emergencies of practice and to
deal with them in the ordinary way. As students, their time, money, and
zeal for study and investigation, are all usually more or less limited, and
there are many things in a course in what is called the "higher medical edu-
cation" which are of comparatively little use to them. The clinical instruc-
tion which they can get at a school in the region of country in which
they intend to practice will often be more valuable to them than that
which they could get at a distant school of greater repute, simply from
the difference in the class of cases presenting themselves for treatment.
"Good local pilots are in demand, although we have a Superintendent
of the Coast Survey." In some respects, the old fashioned system of
medical apprenticeships, in which the student spent from one to three
years in the office of a physician in general practice before he went to a
medical school to hear lectures, was a good one for producing these gen-
eral practitioners. To learn to do such work easily and properly one must
live among the sick, learn how they look, how they talk, how they are
to be talked to and handled; and must do this at close quarters, and not
by looking on from the top bench of an amphitheatre, or from the
outer ring of a group of thirty or forty men standing around a bed.
Moreover, it is the common everyday ailments and their effects and
treatment that the student wants to become familiar with at first, rather
than the rare cases. Cases of colic, of effects of over eating or drinking,
of sore throats, croup or diphtheria, or scarlet fever or mumps, or the
ordinary fevers, of simple fractures and dislocations, of bad cuts of the

IDEALS OF MEDICAL EDUCATION

211

palm of the hand — are far more important to him from a business
point of view than brain tumors or ligations of the innominate artery.

And these comparatively simple, every-day cases are just what the
young man reading in the office of his preceptor may become familiar
with. How many of the men without such experience, who graduate
this year at our great medical schools, have ever seen closely a case of
measles, or scarlet fever, or incipient small-pox — or have actually looked
into the throat of a child suffering from diphtheria, or have ever assisted
in adjusting and dressing a fractured thigh bone, or in getting the
clothing off from a case of extensive burn or scald? I have no doubt
most of them could repeat the descriptions of these things which they
have heard or read, but they are not as well prepared to deal with such
cases in that unhesitating way which commands confidence, as is the
man who has seen and touched one or two such cases in his preceptor's
office, and has observed what that preceptor said and did. On the other
hand, the number of practising physicians who are qualified to act as
preceptors, and who are willing to give the requisite time and attention
to students, is very limited, — and with any other kind of preceptor, the
student wastes much time, is apt to lose interest, and becomes idle and
unfit for continuous mental effort.

If the student spent his apprentice year, or two years, in a preceptor's
office either at the end of his first or second year's medical lectures, or
after obtaining his degree, it would be much better for him, — but the
latter course is open to the objection that he would probably think that
he knew more than his preceptor. The Scotch medical schools prefer
that the year spent as an articled pupil shall come after the first two
years of education in a medical school. The decision of the British
Medical Council has been that a five years' course of study shall be
compulsory, and that the last year shall be spent in practical work.

Theoretically there is still a considerable amount of preliminary read-
ing with a preceptor done in this country, but practially, this method of
beginning the study of medicine is fast disappearing. Through the kind-
ness of the officers of some of our large medical schools, I have obtained
some data on this point from which I infer that in the eastern schools
the proportion of students who claim to have read with a preceptor for
one year before commencing lectures, is from 1.5 to 30 per cent., and in
western and southern schools, from 25 to 60 per cent., but no doubt
such reading, in the majority of cases, was merely nominal, and the
student had seen little or nothing of practice. In most schools the certifi-
cate of the preceptor is not required.

The ideal of the average student who is in a hurry to begin practice
needs no special description. What he wants is to pass the examinations

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JOHN SHAW BILLINGS

with the least possible labor, — the less he is compelled to take for his
money the better he is pleased. The ideal of the majority of the medical
profession as to what should be the minimum course of study for the
degree of M. D. appears to be that the student should first obtain at least
such a preliminary education as is furnished by our ordinary high schools,
and then should study medicine four years, the first of which may be
with a preceptor, and three of which are to be occupied in attending a
graded course of lectures, the last two years being largely devoted to
clinical and hospital instruction. About one-third of our medical
schools have expressed their intention of carrying out this programme.
As regards the time, it is not sufficient, according to European standards,
but is perhaps the best general standard which can be fixed at present
for the education of the general practitioner for this country. Its success
depends upon whether the student has had the needed preliminary
education. It is the want of this last which is the chief deficiency.

The ideal of the Army and Navy Examining Boards is that a Surgeon
in the Government service should have received either the literary,
classical, and mathematical training of the ordinary college course for
the degree of Bachelor of Arts, or the training leading to a degree in
scientific studies — and that after that he should have spent five years in
medical studies, the last year as resident in a hospital.

This ideal cannot yet be enforced in either service, for the reason that
they could not get enough men who come up to this standard to fill the
vacancies, so that the actual standard is somewhat lower than this, al-
though it is higher than the minimum standard of any medical school or
of any State Board of Examiners. Through the courtesy of the Surgeon
Generals of the Army and Navy, I am able to give you the following
results of the work of their Examining Boards for the last ten years.

Before the Army Boards 348 candidates presented themselves during
this period, of whom 76, or 22.3 per cent, were approved and passed; 31
were rejected for physical disqualifications; 90 failed to pass the pre-
liminary examination; and the remainder failed to pass the medical
examination. The rejections for physical defects are for the last three
years only.

Before the Navy Boards 237 candidates presented themselves, of whom
55, or 23.1 per cent, were approved and passed; 75 were rejected for
physical disqualifications; and the remainder either withdrew or failed
to pass.

Evidently the standards of the two Boards are about the same. The
proportion of those rejected for physical defects is noteworthy. In a gen-
eral way we may say that about one-fourth of the candidates before such
boards are approved — and one-fourth fail on the preliminary examina-

IDEALS OF MEDICAL EDUCATION

213

tion as to general education. Putting aside those rejected for physical
causes, and making the necessary corrections for a certain number who
come before the Boards more than once, we find that of 429 examined,
129 or 30.2 per cent, were successful.

Of those candidates who had a college degree, 34 per cent, succeeded,
and of those who had no such degree, 28.9 per cent, succeeded. Of those
candidates who had had one year's residence in hospital, 40 per cent,
passed, while of those who had not been residents, only 21 per cent, were
successful. The percentage of successful candidates from different schools
varies greatly, ranging from 9 to 56 per cent, for those schools from
which more than ten candidates presented themselves. I cannot go into
details on this point, but may say that taking the Medical Schools of
Harvard, Yale, the College of Physicians, and Bellevue Hospital of New
York, the University of Pennsylvania, and the University of Virginia
together, of 141 candidates, 65 or 46.1 per cent, succeeded, while for all
the rest of the schools in a body, of 286 candidates, 64 or 22.3 per cent,
succeeded.

The figures from Yale alone, are too small to draw accurate conclu-
sions from, but in strict confidence I will tell you that of the five gradu-
ates of the Yale Medical School who come before the Army and Navy
Boards during the last ten years, three, or 66.6 per cent, have passed.
The greatest percentage of successful candidates comes from those who
were between 24 and 25 years of age when they graduated, being 31.7
per cent, as against 27.9 per cent, for those who were under 22, and 26.2
per cent, for those who were over 25 on graduation.

Admitting it to be a fact that different schools have different minimum
standards for graduating Doctors of Medicine, to what extent are these
differences necessary, or desirable? There is at present a very general
demand that those schools which have the lower standards shall raise
them to the ideal of the medical profession just stated. It seems as if
the supply of physicians is now, in most parts of the country, in excess of
the demand, the number of medical men being from two to three times
as great among us, in proportion to the population, as it is in France or
Germany, while the annual number of graduates also greatly exceeds
the number of places to be filled.

Under these circumstances, there is necessarily a struggle for existence
in which the men of inferior qualifications usually, though not always,
fail. The schools, however, will not shape their course so much with
reference to the real or supposed interests of the profession or of the
public, as with reference to the demands of their immediate customers,
the students, and many of these, as has been said, do not want any more
education than is absolutely necessary to enable them to begin practice.

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JOHN SHAW BILLINGS

The ability and inclination to pay for professional services differs
greatly in different localities, and among different classes of people. At-
tempts to enforce a minimum time for the course, and a minimum for
the number of lectures in certain specified branches, will not result in
fixing an uniform minimum of results obtained, for this can only be
assured and maintained by some system of inspection and testing of
results which is independent of the schools, or, at all events, of each
individual school. When, as Professor Sumner says: "A and B put their
heads together to see what C ought to be made to do for D," there is
small prospect of result so long as C is free to do as he likes.

In the Russian myth, when the raven brought the water of life and
the water of death to the gray wolf, the first thing that the wolf did was
to test their powers on the raven himself to determine whether his
task was properly done. The public do not have an opportunity of
seeing the effect of such a test as this upon those who come to them from
the schools professing to have obtained the knowledge of healing; if
they had, the complaints of overcrowding in the profession would prob-
ably cease.

From a commercial point of view it seems plain that there are too
many medical schools in this country, that the education which many
of them are giving is a very poor one, and that the students who are
attracted to these last by offers of a cheap and short course, waste
their time and their money.

The only really efficient remedy for this state of affairs is a system of
State examinations with minimum standards. This also has its evils,
since it must lead to cramming, but it is the best we can do at present.
It is urged by some that this minimum standard should be uniform
throughout the United States — but in that case, it would be unnecessarily
low in some parts of the country. The precise nature of the requirements
in different regions depend on the density of population, and on the
ability of the great mass of the people to pay enough to induce highly
educated physicians to settle among them. It would be better if it were
otherwise, and if everyone could have the benefit of the best professional
skill, but matters are adjusted in this world largely by conflict of
interests. Certainly no one who intends to practice medicine should be
content with the least amount of knowledge which will enable him to
pass the required examinations, whatever the standard of those examina-
tions may be. Putting aside now this matter of a minimum standard,
let us consider briefly an ideal of a medical education of a higher type.

In addition to the incipient family practitioner of ordinary qualifica-
tions— the beginners in the profession — there is need of, and employ-
ment for, highly skilled, thoroughly trained physicians and surgeons as

IDEALS OF MEDICAL EDUCATION

215

family physicians, as consultants, as specialists, and as investigators and
teachers.

There are two ways in which these needed men may be educated and
developed. The first is by their commencing with the ordinary course of
instruction for general practice in the manner just spoken of, and then
going on, after graduation and commencing practice, to study and perfect
themselves in details — according to individual tastes and opportunities;
and this has been the course pursued by a large number of our most
distinguished American consultants and specialists. The other is to lay
a broad and sound foundation of preliminary education before giving
any attention to clinical study or practice. This means an education at
least equivalent to that required of candidates for the degree of Bachelor
of Arts from our leading universities, including Latin, French, and
German, and mathematics to include trigonometry, and the elements of
analytics. It should also include one year's work in a physical laboratory,
two years' work in chemistry, two years' work in biology, — at least one
year's work in practical anatomy — and one year's course in materia medica.

In other words, it requires that the youth of sixteen, having obtained
a good high school education, shall go on to spend at least five years in
additional study before he commences to see anything of practice. He
should then spend at least three years more in special medical and
clinical studies, during one year of which he should, if possible, reside
in a hospital. If then his purpose is to become a specialist, an original
investigator and a teacher, it is desirable that he should spend two years
more in clinics and laboratories devoted to his special subject — and at
least half of this time should, at present, be spent abroad. These are the
broad outlines of what I suppose most physicians of the present day would
consider a desirable scheme of medical education for an intelligent boy
with a fair amount of liking for study, good health, and sufficient
means to enable him to go through with it without making undue de-
mands upon his parents or guardians.

You will observe that there are several qualifying clauses in that last
sentence. The aphorism that it does not pay to give a five thousand
dollar education to a five dollar boy, must be constantly borne in mind
in considering these questions. On the other hand, it is also to be noted
that in the preparation of educational schemes, it is not necessary to
provide for the demands of youths of extraordinary ability and industry

for men of genius. Beds suitable for giants are not required as part of

the stock of an ordinary furniture store, especially if it require giants
to make them. Some cases of disease will recover without treatment,
though the cure may be hastened by proper management, some will
die under any treatment, the result of some depends on the treatment.

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JOHN SHAW BILLINGS

It is much the same in education. Some will acquire knowledge and
power without special training, — others will never acquire those things
under any training, but the career of many depends, to a large extent,
on the training which they receive. The recent announcement of a
compulsory four years course of medical studies by Harvard and the
University of Pennsylvania, soon to be followed by a similar announcement
from Columbia, looks towards this ideal.

The number of those who are obtaining a college education as a
preparation for medical study has increased, and will still more increase
as the competition among an excessive number of physicians becomes
fiercer.

From information received from some of our leading medical schools
for the present year, it appears that the proportion of students who have
taken preliminary degrees before commencing the study of medicine
varies from 14 to 43 per cent, in eastern schools, from 3 to 12 per cent,
in western schools, and from 15 to 20 per cent, in southern schools.

Just here comes in a very difficult point. When shall general education
cease and special training begin? The answer to this must depend largely
on the individual, but it seems to me that the present tendency is to begin
to specialize too soon. This early specialization of study and work may
lead to more prompt pecuniary success, but not, I think, to so much
ultimate happiness and usefulness as the longer continuance of study
on broader lines. "For it is in knowledge as it is in plants: if you mean to
use the plant it is no matter for the roots; but if you mean to remove it to
grow, then it is more assured to rest upon root than slips; so the delivery of
knowledge as it is now used, is of fair bodies of trees without the roots —
good for the carpenter but not for the planter. But if you will have science
grow, it is less matter for the shaft of body of the tree, so you look well to
the taking up of the roots." 1

In discussions on medical education and the duties of medical schools,
we are too apt to lose sight of the fact that the best that the student can
do in them is to begin to learn. If he does not study much longer and
harder after he graduates than he does before, he will not become a
successful physician. Moreover, the great majority of men have different
capacities for learning certain things at different ages. They lose receptive
power as they grow older.

Permit me to use here a personal illustration, and pardon the ap-
parent egotism of an old gentleman who refers to his youthful days.
Thirty-three years ago I began the study of medicine, having obtained
the degree of Bachelor of Arts after the usual classical course of those
days. It so happens that the smattering of Latin and Greek which I

1 Lord Bacon.

IDEALS OF MEDICAL EDUCATION

217

obtained has been of great use to me, and I may, therefore, be a prej-
udiced witness, but my acquaintance with many physicians at home and
abroad has led me to believe that the ordinary college course in lan-
guages, mathematics, and literature is a very good foundation for the
study of medicine, and I do not sympathize with those who demand that
all who are to enter on this study shall substitute scientific studies for all
the Greek and a part of the Latin of the usual course. This change is
good for some but not for all. I had attended lectures in physics and
chemistry but had done no laboratory work, and I could read easy
French and German. Thus equipped I began to read anatomy, physiol-
ogy, and the principles of medicine. Nominally I had a preceptor — but
I do not think I saw him six times during the year which followed, for
I was teaching school in another State. Nevertheless, he told me what
books to read, and I read them. The next thing was to attend the pre-
scribed two courses of lectures in a medical college in Cincinnati. Each
course lasted about five months and was precisely the same. There was no
laboratory course, and I began to attend clinical lectures the first day
of the first course. One result of this was that I had to learn chemical
manipulation, the practical use of the microscope, etc., at a later period
when it was much more difficult. In fact I may say that I have been
studying ever since to repair the deficiencies in my medical training and
have never been able to catch up.

Probably a large number of physicians over fifty years of age have had
much the same experience, and felt that there are certain things, such
as the relation of trimethyloxyethylene-ammonium hydroxide in the
body, or the causation of muscular contraction by migration of labile
material between the inotagmata — the bearings and beauty of which
might as well be left to younger men. Not that these things are specially
difficult to understand, but they form a part of a new nomenclature
which in most cases it is not worth the while of the older men to learn,
because it is far more difficult for them to master it than it is for their sons.
One of the most comfortable and satisfactory periods in a man's life is
that when he first distinctly and clearly recognizes that in certain matters
he is a hopelessly old fogy, and that he is not expected to know anything
about them.

Having thus roughly sketched what is wanted in the way of medical
education by different classes of students — the article for which there is
market, let us next consider briefly what an university may wisely at-
tempt to provide in this direction. Some suggestions on this point may
perhaps be obtained from an examination of the condition of affairs as
regards medical education in the University of Oxford.

The Corporation of Oxford has a little more than half the number

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JOHN SHAW BILLINGS

of inhabitants possessed by the City of New Haven, and its relations to
London are, in many respects, similar to those of New Haven with the
cities of New York and Boston. For a number of years it has been urged
by some physicians in England, that the University of Oxford, with her
great resources, has not been doing as much for medical education as
she should have done, and that it is her duty to establish and maintain
a completely organized medical school of the usual pattern, using the
small local hospital and dispensary facilities for the clinical side of the
work-
On the other hand, other physicians, of whom my friend Sir Henry
Acland may be taken as the representative, maintain that it is much
better that Oxford should use her resources in giving a broad founda-
tion of literary and scientific culture, including, for those who propose
to study medicine, the means of special instruction in general biology —
and comparative and human anatomy, physiology, and pathology — and
that the men thus prepared should go to the great Hospital Medical
Schools of London to obtain their clinical training, after which, they
may return and pass their final examinations and obtain the coveted
degree of Doctor of Medicine from the university.

There is no doubt that this can be done, and that a great part of the
scientific foundation of a complete medical training can be furnished
by a well equipped university, with little or no reference to clinical
instruction at the same time and place. This, for example, is the course
followed by many of the students in the medical department of the
University of Virginia, and it seems to be that there is also no doubt
that the men who go through such a course of training, followed by
clinical training in a great city, will have a better course of instruction,
a wider experience, and a better chance of seeing and appreciating the
methods of great clinical teachers, than would the majority of those
who obtained their clinical as well as their scientific training in the small
town, or than those who obtain all their instruction in a large school
devoted exclusively to medical studies. Upon this last point I need not
dwell, for Dr. Welch, in his address before you in 1888, has clearly
pointed out the advantages of giving to a medical school an university
atmosphere, and of making the union of the school and the university
close and intimate. It should be noted, however, that the more true this
is, the more it is the duty of an university to maintain such a school,
because educational work which cannot be, or is not, done so well else-
where, has superior claims upon university aid. The chief thing which
can be said in favor of the attempt to attract a large number of medical
students of average qualifications to an institution having the means to
give the higher education are, first, that it brings in more money — and,

IDEALS OF MEDICAL EDUCATION

219

second, that it enables those professors who desire advanced workers,
to select these from a somewhat wider field. Also it should be remem-
bered that the small hospitals of from 50 to 100 beds should be fully
utilized for clinical teaching, even if they cannot furnish all the clinical
material that is desirable for a complete course of instruction.

It must be confessed that nearly all our great American universities
are unwilling to apply their funds to the creation and maintenance of a
well equipped medical department. They are willing to have such a de-
partment no doubt, but they want the money for establishing and main-
taining it to be provided in addition to the money which has been, or is
to be, provided for the general purposes of the university. The ideal
university culture of the present day appears to be designed to fit a
man to take pleasure in his own thoughts and musings, and in mental
exercise in languages, literature, the higher mathematics, and the prob-
lems of physics and natural history. Incidentally his knowledge of these
things may not only give him pleasure, but enable him to help others,
but the studies are not to be pursued on account of any practical
utility which they possess, but for the love of learning and pure science,
i.e. for personal gratification of a particular kind. Those who hold these
views are apt to consider medicine as a technological matter, which
should be left altogether to special schools, because, being practically
useful in a commercial sense, the means of teaching it are sure to be
provided through commercial interests, just as they are sure to be pro-
vided for the teaching of practical engineering. This is far from the old
university idea as embodied in the three faculties and four nations of
the University of Paris. So far as the interests of the public are con-
cerned, it is only the possession and control of a large amount and variety
of clinical material, or of unusually qualified clinical teachers, which
makes it the positive duty to use it, or them, for purposes of medical in-
struction in order to train ordinary general practitioners of medicine.
There is no present deficiency in the number of such practitioners, and
we certainly have plenty of schools for producing them, so that there is
no fear of failure in the supply.

But in medicine as in every other profession, art, or trade, the supply
of the best is never too great, and the demand for something better than
that which already exists never ceases.

What then does an university, or its medical school, need in order
that it may be able to supply the demand for this higher medical educa-
tion? First, — competent teachers. Second, — suitable buildings, collections,
books, and apparatus. Third, — clinical material. To secure and retain
these things requires money, and brains to use it. First as to the com-
petent teachers. There are many teachers available — but the number of

220

JOHN SHAW BILLINGS

these who have shown that they are competent for and suited to posi-
tions in a medical school which is to supply the best and something
better, is limited — much more so than one who had not tried to find
them would suppose, and these few are not seeking engagements. How
many anatomists, or physiologists, or pathologists, of the first class,
thoroughly trained, authorities in their special fields, capable of increas-
ing knowledge, and with the peculiar gift of ability to teach — do you
suppose there are in this country? It is a liberal estimate to say that a
dozen of each have thus far given evidence that they exist. And the
great clinical teachers in medicine and surgery, — the men who are up
to the times in matters of diagnosis, pathology, and therapeutics, and
who are also successful teachers both by the spoken and written word —
how many such have we — and especially how many such have we who
are not fixed and established, so that they may be induced to go to a
school which needs them? Such men are either men of genius, and even
this boasted nineteenth century has produced them rarely, or they are
men of talent made the most of by unflagging industry with special op-
portunities, and they are also rare. Yet these are the men whom a great
university should seek to obtain, and retain, for her faculties. To do
this, and to get the best work from such men, is by no means a mere
matter of salary, although sufficient salaries must be paid. We have also
to consider the buildings, collections, books, and apparatus required,
and this is largely a question of money. How much money? What would
be the cost of establishing and maintaining a first-class medical school
in this country at the present time? Let us suppose that 150 students are
to be provided for — that the course of instruction for those coming with
a good high school education is to occupy four years, and for those com-
ing with the degree of Bachelor of Arts, and having done at least one
year's work in a chemical laboratory and one year's work in a biological
laboratory, the course shall occupy three years, that the last year's studies
shall be almost exclusively clinical, and that provision is to be made for
advanced post-graduate work.

We shall want then, practical anatomy rooms for 50 students, a physio-
logical laboratory, a pathological laboratory, a pharmacological labo-
ratory, a laboratory of hygiene, and the means of clinical teaching, a library
and a museum. The days have long gone by when one or two amphi-
theatres or lecture rooms and a small museum, were all the outfit re-
quired for medical teaching. The little amphitheatre of the University of
Bologna was sufficient for almost every purpose of medical teaching as
that was carried on three hundred years ago, but now the lecture room
is the smallest part of the outfit required. In his evidence before the Royal
Commission, Professor Lankester stated that to establish such a Medical

IDEALS OF MEDICAL EDUCATION

221

School at Oxford as he thought desirable, about $225,000 would be re-
quired for buildings in addition to those already existing, and that about
$100,000 a year would be required for running expenses. Professor Bill-
roth estimates that about $400,000 would be required for buildings for
the medical department of a univeristy, exclusive of the building for
clinical teaching, which he thinks would cost about as much more, — and
that the annual expense would be about $105,000. He says that these
estimates are based on an average standard of efficiency — not the highest
— and concludes by saying, "let us hope that a rich man may some day
give three millions of dollars to found a school to be devoted to medicine
and natural science."

Perhaps these figures may seem high to you. Yet building is cheaper,
and salaries lower in England and in Germany than with us — if only
first-class work and first-class men are accepted. To build and equip a
laboratory which shall give work room for 75 men, will cost here between
$75,000 and $100,000. At least four such laboratories are needed by the
ideal medical department, besides a building for general lectures, library,
etc., which would cost about $50,000.

It is of course possible to consolidate all these into a single three or
four story building and thus save money, especially in cost of ground —
but the results are not so good. I am not speaking now of temporary
makeshift buildings, but of permanent structures — which, though plain,
should not be hideous, and should be thoroughly well built. Where land
is abundant and not too dear, it is usually better to construct these labora-
tories one at a time and endeavor to secure for each, a proper endowment
and equipment. The average expenses of each laboratory may be put at
$15,000 per annum. In other words, it requires about $400,000 to build,
equip, and endow a physiological, pathological, or hygienic laboratory
such as is suited to the needs of a first-class university in this country. By
paring down in various directions, this sum can be reduced to $300,000,
but not lower without seriously impairing the efficiency of the plan. And
in all this I have said nothing of the cost of the means for clinical in-
struction— which should be borne, in part, at least, by the school, for the
simple reason that only by doing this can the school have that control of
hospital appointments which is so necessary for its proper work.

Of course every professor who is skilled and energetic, and who is
imbued with the true university spirit, has innumerable wants and sugges-
tions which require money to supply and carry out. He wants the new
books and journals relating to his specialty, specimens, apparatus, models
and illustrations, and if he is at the head of one of the laboratories which
I have named, the sum of $15,000 per annum will be required to pay him
and his assistants, and to provide for their needs. All this means that the

222

JOHN SHAW BILLINGS

educating of physicians on this plan will cost the medical department
between four and five thousand dollars for each graduate. It will receive
from them $800 to $1,000 each, and the balance must be made up from
subscriptions, appropriations, or endowments. Practically endowment is
the only resource.

The student himself has to give four or five years time and labor and
four or five thousand dollars to obtain his medical education. For some,
this expenditure of time and money will be an excellent investment — for
others not, even if they have enough of both to spare for this purpose.
After all, the most that the university can do is to afford opportunities for
learning, and a certain kind and amount of stimulus to mental work. The
professor may declare that he will teach certain branches, but there are
some sent to him for instruction who are not teachable, and the only
thing he can do is to return them as little damaged as possible.

The number of men for whom it is specially desirable to provide
laboratory and other special facilities for original work in physiology,
pathology, pharmacology, and hygiene, is limited. There are not a great
number of men who have the desire and the qualifications necessary for
this sort of work, and the number of positions in which they can find
remunerative employment in devoting themselves to such investigations,
is still more limited.

The laboratory facilities in Germany are, as a whole, at present in
excess of the number of properly qualified men who can be found to make
use of them, although a few are overcrowded.

Advanced work and original investigations cannot, as a rule, be made
by undergraduates, if for no other reason than that of lack of time.

Is it advisable that the same medical school shall undertake to furnish
such different courses as to provide for all wants — to offer to meet the
minimum requirements for the Degree of Doctor of Medicine, as well as
the wants of those who demand more advanced and detailed instruction?
The answer to this depends largely on the location of the school, and on
the means which it can command, especially as regards facilities for hos-
pital and clinical instruction. In any case, its diploma of Doctor of Medi-
cine should have an uniform value, and if it does undertake the double
function, the higher education must be largely post-graduate work. It
must also be, to a great extent, a voluntary matter on the part of both
schools and students.

As indicated at the beginning, this address is not intended to criticize
existing medical institutions, or to give specific advice to any college or
university. I have simply tried to formulate roughly what seems to be the
present ideal of a course of medical education in the minds of many

IDEALS OF MEDICAL EDUCATION

223

physicians, and then to show what the carrying out of this ideal involves
to the schools and to the students.

I believe in ideals — that is in their beauty, and in their utility when
they do not dominate a man so as to make him a visionary, or a dangerous
crank or fanatic, — but one ideal is often more or less incompatible with
another, and all of them must be held subject to the possibilities af-
forded by surrounding circumstances. But we must not be too skeptical
about these possibilities. And we are all directly interested in this matter
— every one of us. Every one of this audience will probably see the time
when the knowledge and skill of the physician called in to advise in the
calamity which has fallen on him, or his wife, or child, will seem to him
of vast importance.

Sometimes he can select his physician — often he cannot — but must rely
on the first one who can be found. Hence these discussions about medical
education, although chiefly carried on by physicians, because they are
most familiar with the difficulties of the subject, should be considered by
those who are not physicians quite as much as by those who are, or intend
to be. It is a dangerous business, however, for a doctor to discuss other
doctors in public. He can make more trouble for himself in less time in
this way, than by almost any other method that I know of. Nevertheless,
it is my duty to tell you that there is little probability that the ideal facili-
ties for higher medical education, either here or elsewhere, will be
furnished by the doctors themselves. There are several reasons for this,
but one is sufficient, and that is they have not got the money which I have
shown you is necessary to provide and maintain these facilities. Hence, if
these ideals are to be realized, the means must be furnished by those who
are not members of the medical profession, and it seems to me that this is
what will be done.

What is the best way for a university, a real university, to begin this line
of work? In most cases I should say by establishing one department at a
time on a proper basis. Which departments should be the first to be thus
established? Just here is where many of the doctors will begin to differ.

I should say that the first of these departments to be provided for are
two which will form the main links in the university bond between the
medical and other departments, — covering two branches of knowledge
which every university graduate should study somewhat, namely, biology,
and hygiene. For the clergyman, the teacher, the journalist, and the soci-
ologist, systematic instruction in these two branches is as desirable as it is
for the physician— for the lawyer it will be useful— only the philologist
would I excuse entirely from these departments.

Of course, in specifying that they are to teach,— and to teach under-
graduates, I do not mean that teaching is to be their sole function. This

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JOHN SHAW BILLINGS

is not the modern idea of a scientific department of a true university. It
is to increase knowledge as well — to provide for the needs of special
investigators and seekers who have obtained their elementary training
elsewhere.

Let the plans for such a department be well thought out, the expenses
carefully estimated — and then bring the matter to the attention of those
who have the means to realize this ideal, and sooner or later, it certainly
will be realized. I have elsewhere ventured to express my sympathy for
two classes of men who have in all ages and in all countries received
much disapprobation from philosophers, essayists, and reformers, —
namely, rich men, and those who want to be rich.

So far as the wealthy are concerned, there seem to be a good many of
them in these latter days who use their stored force to endow universities
and professorships, to build libraries and laboratories, and to such let us
give due praise and honor.

They may or may not be scientific men, but at all events they make
scientific men possible. The unscientific mind has been defined as one
which is willing to accept and give opinions without subjecting them to
rigid tests. "This is the kind of mind which most of us share with our
neighbors. It is because we give and accept opinions without subjecting
them to rigid tests" that the sermons of clergymen, the advice of lawyers,
and the prescriptions of physicians have a market value.2 The unscientific
public has its uses, and one of its characteristics is a liking for ideals, some
of which it occasionally helps to realize. I can only hope that whenever
an American university approves the ideal which I have roughly sketched,
this public will see that the means are provided for carrying it out. It
may be objected by some that it would be better to help to raise the
average standard by endowing chairs in the medical schools in large
cities, than to provide special facilities for the use of a limited number.
It is quite true that all medical schools should be endowed — and this is
coming; — for voluntary associations of physicians — who are not a wealthy
class — cannot afford to compete with endowed schools, when State laws
shall come to enforce a higher standard of acquirements. Nevertheless,
we need universities properly so-called, as well as colleges and higher
schools, and we need university men in the medical profession as well as
elsewhere.

1 have no fears as to the creation of a medical aristocracy by giving
facilities for higher education to those who have the means to avail
themselves of them. It is quite true that only a fraction of those who have
the means will use these facilities properly — and that there will be a
number who have not the means who would make good use of such

2 Scientific Men and their Duties, by J. S. Billings, Washington, 1886.

IDEALS OF MEDICAL EDUCATION

225

facilities if they could get them — but these last will not be helped by the
total absence of such facilities for anybody. Let us try to give the best
minds a chance to obtain the best training — let us try to discover these
best minds wherever they may be — and if their owners have not the means
to avail themselves of training, let us try to furnish the means — but to do
this, one of the first and most essential steps is to provide somewhere the
teachers, and the buildings, and apparatus necessary for giving such
instruction, and where is a better place to do this than in connection
with an university? — or, if you please, in connection with this University?

The Conditions and Prospects of the
Library of the Surgeon-General's
Office, and of its Index Catalogue

Of late years those physicians in this country who make use of medical
literature in connection with their investigations or writings, have, for
the most part, become acquainted with the resources of the "Library of
the Surgeon-General's Office," as it is officially designated, and many of
them are much interested in its progress and prospects. I am often asked
how the collection is progressing, how near it is to completion, what it is
most in need of, when the Index Catalogue will be done, whether it will
be followed by a supplement, whether there is danger that the work of
the Library may be checked in the future through changes in administra-
tion, and so on. These manifestations of interest are, of course, very
gratifying, and when the Chairman of your Programme Committee de-
manded a ten-minute paper from me on this occasion it occurred to me
that I would try to answer some of the foregoing questions so far as I am
able to do so.

The present condition of the Library is fairly satisfactory. It now con-
tains 102,000 volumes and 152,000 pamphlets, counting as pamphlets all
octavos and smaller sizes having less than 100 pages, and all quartos of less
than 50 pages. During the last five years, i.e., from July 1, 1886, to June
30, 1891, the additions to it have included 25,237 volumes and 55,900
pamphlets, or an average of 5000 volumes and nearly 12,000 pamphlets
yearly. Of this annual increase, about 2000 volumes and 4000 pamphlets
have been of new or current literature, and the remainder have been
publications of previous years or centuries. About one-fifth of these
accessions, of both new and old literature, have been presented, the re-
mainder have been purchased. So far as mere size goes, it is the largest
collection of medical literature in the world, and for the last five years
has been increasing more rapidly than any other similar library con-
taining 25,000 volumes and upward. It is especially rich in medical
periodicals and transactions of societies, of which classes it now contains
about 34,350 volumes. The American, English, French and German
literature in all branches of medicine which has appeared during the

Read before the Association of American Physicians, at its Sixth Annual Session,
Washington, September 25, 1891. Transactions of the Association of American Physi-
cians 6: 251-7 (1891).

226

CONDITION AND PROSPECTS OF THE LSGO

227

present century is very fully represented, and over 90 per cent, of all the
medical literature of the world for the last ten years is in the library. The
whole is conveniently arranged in a fire-proof building, and is catalogued.

So much for the favorable side of the situation; now for a statement of
some of the principal defects and deficiencies. Of medical incunabula, it
contains 140 volumes, or about one-eighth of the medical works published
prior to 1500. Of the published works of the ancient Greek, Roman, Arab
and Hebrew medical authors, it has one or more editions of nearly all,
but these editions are not in every instance the best. Of the early Spanish
and Portuguese medical literature, it has almost nothing; of French
medical works of the sixteenth century, but little; of French medical
theses prior to 1800, very few. Of the English, French and German medical
books of the 16th, 17th, and 18th centuries, which are of any importance
historically or practically, it has about 75 per cent.; of the Italian, about
50 per cent.; and of the Spanish, about 25 per cent. In its periodical
literature it is especially deficient in the Spanish and Italian prior to
about 1850, in the French prior to 1780, and in the Russian prior to 1860.
If I could add to it about ten thousand volumes of my own selection, it
would, I think, contain at least one edition of every medical work of any
practical use or importance which has ever been published, although it
would still not possess some fifty thousand pamphlets and theses, each of
which might be of some historical interest.

These deficiencies in the Library are being gradually supplied, but the
acquisition of the older books and pamphlets which are still wanted is
becoming every year a slower, more difficult, and more costly process. This
is due to the fact that the books still wanted are many of them rare, and
only appear in the market at intervals of from five to fifty years; to the
fact that the number of competitors for such books is increasing, and,
above all, to the fact that the expenditure of time required for the ex-
amination of the numerous catalogues and lists received at the Library, in
order to select those books which are still wanted, is becoming very great
in proportion to the results obtained. To check off a catalogue of a
thousand medical books with the result of finding about four which are
really desirable, a dozen which may be accepted as filling gaps, and about
twenty small theses which are not in the collection, involves an amount of
clerical work which costs as much as, if not more than, the books thus
obtained. In one sense, it is true that this is a satisfactory condition for a
library to be in, but, nevertheless, the time spent in such checking is to
be regretted.

With regard to current medical literature, the amount increases each
year, but the rate of increase is becoming slower. Comparing the period of
1890 with that of 1880, we find that the number of medical writers in-

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JOHN SHAW BILLINGS

creased from 11,600 to about 14,200, or a little over 22 per cent. There
were published in 1890 about 2000 volumes and 4000 theses, pamphlets,
and reports in medical literature. Of the volumes, about 930, or not
quite half, were furnished by medical journals and transactions, as
against 864 of the same kind in 1880 — being an increase of about 7i/2
per cent. Excluding the journals, transactions, and theses, the number of
medical books and pamphlets published in 1890 was about 1,850 as
against 1,600 in 1880 — being an increase of about I5y2 per cent. This
indicates that the increase in the number of medical writers, and in the
quantity of medical literature which they have produced, has not been
proportionally as great as the increase in population and in the number
of physicians in civilized countries during the decade, which confirms the
statement which I made ten years ago, that the rate of increase is becom-
ing smaller.

In the United States the proportion of periodical literature to the whole
is much greater than it is in other countries — for in 1890 it produced
about 250 volumes of medical periodicals, 60 volumes of new medical
books, 20 volumes of later editions, and 28 volumes of reprints of English
books and transactions; while France produced about 160 volumes of
medical periodicals, 250 volumes of new medical books, 20 volumes of
later editions, and 15 volumes of transactions; Great Britain about 85
volumes of periodicals, 140 new books, 45 volumes of later editions, and
12 volumes of transactions; and Germany about 175 volumes of medical
periodicals, 175 volumes of new books, 80 volumes of later editions, and a
dozen volumes of transactions. All this is exclusive of pamphlets. Of
course, quantity in medical literature has no definite relations with
quality or value, but I am speaking now merely with reference to the
number of separate pieces which are to be obtained, catalogued, and
cared for, and you will see that including journals, transactions, reports,
books, pamphlets, reprints, and theses, we shall have at least 6000 new
pieces to provide for this year. The indexing of articles in journals and
transactions will involve the writing and classifying of about 25,000 titles
in addition.

Of the Index Catalogue of the Library, twelve volumes have now been
printed — carrying the work to S. The thirteenth volume is nearly ready
for the press, and the manuscript for the rest of the work — at least two
volumes more — has been prepared, but has not yet been finally corrected
and arranged. As we can print but one volume a year, it is evident that
during the twelve years which have elapsed since the publication was
commenced a large number of titles of books and articles received too late
to be placed in their proper places must have accumulated, and this
accumulation becomes more rapid every year as we get further down the

CONDITION AND PROSPECTS OF THE LSGO

229

alphabet in the course of printing the work. At present the number of
unprinted titles thus accumulated under authors and subjects down to S,
probably amounts to about 70,000 author and 240,000 subject titles, the
latter of course including the titles of indexed journal articles. If these
were now printed they would make about four volumes of the size of the
volumes of the Index Catalogue, and three years hence, when this first
series of the Catalogue is finished, there will probably be material on hand
enough to form at least five volumes of a supplement or second series,
which will no doubt expand into six volumes by the time the printing of
this second series is finished — that is, if the library continues to increase
as it has done for the last five years.

The twelve volumes of the Index Catalogue already printed contain
137,578 author titles covering 66,855 volumes and 120,000 pamphlets,
522,092 subject titles covering 128,284 titles of books and pamphlets, and
393,808 articles in journals and transactions. The titles of articles in
journals and transactions are printed only under subject headings, those
of books and separately paged pamphlets and reprints are printed twice
— once under the name of the author and once under the name of the
subject. All the cards for journal articles have been preserved, and when
the printing of the Catalogue is completed, it is proposed to assort these
by authors so as to bring under each man's name the title of all the arti-
cles he has written which have been indexed. Whether this will ever be
printed I do not know. The chief errors in the Index Catalogue are those
of omission. About fifty serious errors in the first twelve volumes have
thus far been detected, but the main defect is the failure to include under
the proper subject headings some books and journal articles which are
in the collection. We have gained experience as the work has progressed,
and the later volumes seem to be more full and accurate than the first.

Of main and subordinate subject headings the Index Catalogue, as a
whole, contains about 20,000, and in placing the proper headings on the
subject cards to indicate where each is to be placed, it is necessary, in
order to secure good results, that the person doing this shall not only
remember the general scheme of classification, but the details of between
four and five thousand of the subject headings used. If he makes an error,
the card goes to the wrong place and is liable to be omitted in printing;
but, in the long run, it is sure to be discovered and placed where it be-
longs.

In connection with the Index Catalogue a few words with regard to the
Index Medicus may be of interest. This, as you know, is in the main a
record of the titles of new books and articles in periodicals received at
the library, to which are added the titles of a few books advertised as
published but not yet received. It is not published by the Government,

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JOHN SHAW BILLINGS

but by Mr. George S. Davis, of Detroit, who pays all expenses connected
with it, and is entitled to the thanks of all who use it for his public spirit
and enterprise in maintaining its existence, since the amount received by
him for subscriptions barely meets the cost of its publication. At present
482 subscriptions are made for this periodical, of which 90 come from the
U. S. Army Medical Department, 224 from the rest of the United States,
and 168 from other countries. Of the subscriptions from foreign countries,
Australia sends 5; Belgium, 2; Brazil, 1; Canada, 2; England, 41; France,
26; Germany and Austro-Hungary, 63; India, 1; Ireland, 2; Italy, 1;
Mexico, 1; Russia, 9; Scotland, 9; Sweden, 2; and Switzerland, 2. Of the
home subscribers, California furnished 8; Colorado, 1; Connecticut, 3;
District of Columbia, 13; Georgia, 2; Illinois, 9; Kentucky, 1; Louisiana,
3; Maine, 2; Maryland, 10; Massachusetts, 31; Michigan, 8; Missouri, 4;
Nebraska, 1; New Jersey, 5; New York, 69; Ohio, 8; Pennsylvania, 33;
Rhode Island, 4; South Carolina, 1; Tennessee, 1; Vermont, 1; Virginia,
1; Wisconsin, 4. For the large cities, the figures are, New York, 50;
Philadelphia, 32; Boston, 24; Baltimore, 10; Cincinnati, 7; Chicago, 6;
San Francisco, 4; Detroit, 4; and St. Louis, 3.

This is the last of the statistics of the Library and matters connected
with it which will be inflicted on you at this time. The figures themselves
may be dull, but some interesting, and even amusing, conclusions may
be drawn from them, which I leave for you to do.

In conclusion, I may say that the future prospects of the Library are
excellent. It is not dependent on the skill or energy, or goodwill, of any
one man; it is becoming more and more known to, and more and more
used by, the members of the medical profession, and so long as they are
interested in it, the necessary appropriations will be made and the
skilled force employed to increase, preserve, and catalogue it. The serv-
ice rendered by a number of those employed in the Library is not a
mere matter of money — they are deeply interested in their work and
proud of the results, and they can and will carry it on and instruct others
who will come after them and do likewise. They have to handle much
rubbish, for the proportion of what is both new and true is not much
greater in medicine than it is in theology, but in a great national collec-
tion this is unavoidable, and the best they can do is to make a first rough
assortment, and then make the whole accessible to those who wish to
use it. There is no doubt that the publication of the Index Catalogue will
be completed, nor that a supplement will speedily follow.

Just at present the most unsatisfactory thing about the Library is the
fact that many of its books and journals are not fully available for use
owing to the fact that we cannot get them bound. Under existing laws
all the binding of the Library must be done at the Government Printing

CONDITION AND PROSPECTS OF THE LSGO

231

Office, which has not room nor men sufficient to do the work required
for the different departments of the Government and for members for
Congress. The result is that the Library now has about 10,000 unbound
volumes, and this number is increasing every year. When a journal is
sent to be bound it may be six months or more before it is returned.
With the erection of additional accommodations for the Government
Printing Office it is to be hoped that this evil will in time be abated;
but there will always be more or less delay in making recent books and
periodicals available for use under the present system. The most effectual
remedy would be a change in the law, whereby the Library could have
its own binding done in its own building and under its own control.

A Card Catalogue of Scientific Literature

Editor of Science — Dear Sir: I presume that there is no doubt of the
existence of considerable demand among workers in, and writers upon,
various branches of science for an index catalogue of the books and papers
relating to the subjects in which they are interested, and that an accu-
rate card catalogue, each card to be promptly furnished as soon as the
book or paper is published, will best meet this demand. It is also desired
that each card should contain a brief summary of the contents of the
article. A large number of investigators and writers would be glad to
have their work done for them by some automatic or mechanical means,
as far as possible, up to a point just short of the conclusions or results.
These, of course, they prefer to prepare and state themselves. Those who
like literary research would be pleased to have cooperative laboratories
established in which, for a moderate annual subscription, they could
have any experiments made which they might suggest, the results to be
reported to them for their use. Others would prefer to do the experiment-
ing themselves, and have someone else tell them everything that other
people have done and written about the matter. And if each party is able
and willing to pay for the assistance he requires, and can find persons
competent to give that assistance and willing to do the work merely for
the pay offered, every one will agree that it is a good thing, and will
furnish new channels of employment and remuneration for experts, for
which channels the need is steadily increasing.

It is, however, not clear that the benefits to science and to humanity,
which would result from a complete card index of science up to date and
available for every one who would like to consult it, would be so great
as to make it the duty of any existing scientific body or institution to
incur the great expense of taking charge of the matter or to contribute
largely to its support.

Physicians meet with some cases for which it is desirable that the food
should be carefully minced and partially digested before it is given, and
sometimes it is necessary to push this food far back on the tongue to make
sure that it will be swallowed, or even to forcibly inject it, but in most
cases this benefits no one but the patient.

There is a very considerable number of men now engaged in preparing

Science 1: 406-8 (April 12, 1895).

232

CATALOGUE OF SCIENTIFIC LITERATURE

233

abstracts and summaries of what is known in various branches of science,
and publishing them as monographs, monthly reviews, year books, etc.;
and in medicine, at all events, the supply of this kind of material is
quite equal to the paying demand for it.

Moreover, it is not certain that the investigator who wishes to know
everything that has been suggested with regard to the subject which he
has under consideration will be much happier when he gets his card
index up to date, if he has not made it himself. He will find references to
articles by Smith, and Schmidt, and Smitovich; but where are the books
containing these articles? Very probably, after a week's hunt and cor-
respondence, he finds that there are one or two of them that are not in
any library accessible to him, and then he is decidedly worse off than
he would be if he did not know that they existed.

It is probable that such complete card catalogues with abstracts would
be the means of adding largely to the bulk of scientific literature, as the
Index Catalogue of the National Medical Library and the Index Medicus
have done to the literature of medicine. The bibliography and the
abstracts will be published over and over again in successive papers by
different writers.

The expediency of having such card indexes prepared depends upon
the cost, and upon whether the money could be used to better advantage
in promoting the increase and diffusion of knowledge in other ways. I
should suppose that $25,000 a year would be a moderate estimate for
providing 25 copies of such a card index for all branches of science, and to
bring the cost within this limit would require careful selection.

If each author were to make his own abstract, and every article thus
abstracted is to be indexed, probably $50,000 a year would be required.
Much might be done for the advancement of science with a fund of
$25,000 per annum.

I do not wish to be understood as opposing the preparation and
furnishing of an universal card index; the schemes proposed are beauti-
ful in the glow and shimmer of their optimism — reminding one of
Chimmie Fadden, "Up t' de limit an' strikin' er great pace t' git on de
odder side of it," but they must be looked at from the practical business
point of view by those who are to defray the cost, and who have, I feel
sure, other important uses for their money and for the skilled brains
required for such work, and more definite information is wanted with
regard to the number of titles, etc., which must be indexed annually upon
such a scheme before a wise decision can be made. For general Biology,
Morphology, Physiology, Bacteriology and scientific Pathology, and other
subjects of scientific importance connected with medicine, I think that

234 JOHN SHAW BILLINGS

about 10,000 cards a year would be sufficient if all second-hand matter
and hash were carefully excluded.

Very truly yours,

J. S. Billings

Washington

The Card Catalogue of a
Great Public Library

Every one admits that a large library must have an author catalogue,
but there are some students, scholars, and librarians who are more
or less doubtful about the relative importance of a subject catalogue,
and as to whether it would not be wiser to use the money which
such a catalogue costs in employing experts in the different departments
of the library to guide and instruct readers, or in purchasing more books.
In favor of this view it is urged that the great majority of readers do not
want a subject catalogue, and will not use it if they can help it. They want
to go directly to the shelves, or else that the attending librarian shall tell
them whether a certain book is in the library, or what is the best edition of a
certain book, or what are the best books on a certain subject, and be-
come impatient when they are requested to examine the catalogue and
fill out order slips for the books selected.

So far as the New York Public Library is concerned this statement is
not correct for ninety per cent, of the readers, but it is true that a con-
siderable number of the casual or occasional readers who come to a
library for information on some specific point, do not know how to use
a catalogue, are not acquainted with the rule on the title-page of the
Washington Directory, viz., "To find a name in this Directory you must
know how to spell it," do not know that McCarty is classed with the
"Macs" and St. Bridget with the Saints, never read the directions on the
guide cards, and when they do find a card containing the title they
want, cannot copy it legibly and fully on the order slip. This proves
that it is necessary to have a special attendant to show such people how
to use the catalogue, but it does not prove that the catalogue is useless.1

It is also said that the person who is making an original research upon
the history of some particular place, period, theory, method, or inven-
tion, has little use for the ordinary subject catalogue, because the data
he wants are for the most part contained in single chapters, or essays,

Read before the New York Library Club, May 9, 1901, Library Journal 26: 377-83
(1901). [Sample subject heading array here somewhat abridged.]

*(A reader in search of a book on "Factory legislation in Europe with special
reference to the hours of labor for women and children," which was entered in our
catalogue under the subjects of "Labor (Female)— Hours of" and "Labor (child) Hours
of,"" gave up his search in despair when he failed to find the title under "Labor-
Hours of," though the guide card for this latter subject plainly referred him to the
two other related subjects.)

235

236

JOHN SHAW BILLINGS

or periodical or newspaper articles, to which the titles of the books or
periodicals give him either no guidance or very little. His ideal library
is one in which he can go to the shelves and search for himself, and
can also go to one of the librarians and ask him "What are the latest
statistics about the birth rate in different countries as compared with the
birth rate in Georgia?" or, "What were the ceremonies at the corona-
tion of Louis Napoleon?" or, "In what cities in the United States
is acetylene used for illumination?" or, "What are the opinions of
scholars as to the origin of the Russian alphabet?" or, "Have you a list
of the marriages and deaths in Bury St. Edmunds in the first half of the
18th century?" or, "What are the text-books on analytical geometry now
used in France and Germany?" or, "Where can I find the best criticism of
the theories of Karl Marx?" or, "Have you a print giving the correct cos-
tume of a Sicilian peasant woman?" and in each case receive a prompt,
definite answer. In other words he wants his bibliography peptonized, and
given to him condensed.

It would be perfectly possible to organize a library staff which should
contain persons capable of answering at least nine-tenths of all
questions of this kind in general history, early American history, Orien-
tal history, Chemistry, Physics, Engineering, Music, Maps, etc., etc.,
after they had made themselves familiar with the resources of the library,
each in his own department. But would their employment do away
with the need for a subject catalogue? I think not — in fact most of these
experts, if in a large library, would desire a subject catalogue and
would make one for their own use — but even if they did not, they will
occasionally be absent, and will sometimes die, and the substitute, or
new professor, will not be able to fill the place for a considerable period
of time.

What does the subject catalogue cost? Let us say five cents per title,
which would make the cost of the present subject catalogue of the
New York Public Library to be about $30,000. It has been five years in
making — or has cost $6000 per year. We might have employed two or
three experts for the same money during that time. Would it have been
wise to do so and omit the subject cataloguing? Probably some who read
this paper will be surprised at the above figures for cost and it may be
of some interest to give the data on which they are based so far as
the Astor collection is concerned. When this card catalogue was com-
menced the books in the library were located by a number indicating
a tier or case of shelves, and a letter indicating the shelf in that tier —
thus 416 C meant that the book ought to be found on the third shelf
of case 416. This had to be changed to a relative location mark under
a new system of classification. Had there been no readers, the easiest

CATALOGUE OF A GREAT PUBLIC LIBRARY

237

and cheapest method would have been to commence at one end of
the library and catalogue every book and pamphlet by author and
subject, putting on each card the new classification mark which would
show its location. But there were readers, and it was desirable to in-
crease their number, hence the new books must be catalogued and made
accessible as fast as possible. The number of purchases was increased —
some large collections were presented — and the total accessions from
these two sources and from exchanges have averaged over 30,000 pieces
per year. The system of classification adopted was in many respects a
new one, which required the actual seeing of the books and pamphets
in working out the details; for only a broad outline could be decided
on at first.

Books and pamphlets, belonging to every department, were pouring
in and these must be located — for which purpose the old system was
used temporarily. The result was that when in the course of classifica-
tion a section was reached which contained a number of these recent
additions — the author and subject cards had to be picked out, the
new marks substituted for the old ones, the books placed in the new
location, and the cards returned to the catalogue. In January, 1896, the
cataloguing staff of the library consisted of one cataloguer at the
Lenox and two at the Astor. This force was gradually increased until
for the last three years the average force has included 20 cataloguers and
18 copyists, producing about 300,000 cards yearly, or an average of
about 1000 cards for each working day. This provided for one set of
author cards for the official catalogue in the catalogue room, and one
set each of author and subject cards for the public catalogue. In addi-
tion about 17,000 index cards for current periodicals were placed in
the public catalogue each year. To file these cards in the official and
public catalogues has kept three of the cataloguing force busy. The
searching in the official catalogue for titles of all purchases except the
newest books, and of all gifts, requires the constant work of one person—
and often of two. One skilled cataloguer is constantly employed on in-
dexing current periodicals, another on indexing public documents, and
another on the manuscripts at the Lenox building.

The chief cataloguer, Mr. Meissner, and his assistant, Mr. Moth, are
engaged mainly in supervision and revision work. One cataloguer
is kept busy with proof-reading. There remain then 14 cataloguers and
14 copyists actually engaged in preparing catalogue cards. Each of these
has one month's vacation during the year, and the cataloguing force
must supply the substitutes when places in the reading department are
temporarily vacated by reason of vacations or sickness, for the readers
department must be kept always efficient. The average production per

238

JOHN SHAW BILLINGS

person has been about 35 cards per day. Many of the readers of this
paper will no doubt think that this is a very slow rate of work, and that
50 cards a day per person would be nearer the proper average. I can
only say that in my opinion the rate of progress has been a fair one con-
sidering the large number of anonymous pamphlets to be looked up in
various bibliographical authorities, the great variety of languages,
and the requirement of fairly full titles with proper collation.

The preparation of author and subject cards, and the filing them in
alphabetical order in the public catalogue, does not by any means com-
plete the proper preparation of this catalogue, and if no more is done
the result will often be very unsatisfactory. The pencil headings on the
subject cards have been placed there by at least half a dozen different
persons acting under general instructions, such as, to use substantives
instead of adjectives for the first or index word as a rule, making an
exception in the case of adjectives indicating nations, races, etc., and for
synonomy to follow in general the "A. L. A. list." No two of them ever
would, or could, assign the same subject headings to a miscellaneous lot of
100 cards, and no one of them would give precisely the same headings this
year to a lot of a thousand cards which he, or she, headed two years
ago. As a rule, they give only the main index word, e.g., "Banking,"
"Commerce," "Shakespeare" — or they will go a step farther and write
"Education (History of)" "Chemistry, Organic," etc., knowing that these
headings are to be revised, furnished with cross-references, and added
to by the librarian in charge of the public catalogue, Miss Henderson.
This final revision, with the preparation of guide cards and references,
can properly only be done by one person, and up to the present that
person has had little time to give to this part of her work. The result
is that if the inquirer is looking for references to the history of educa-
tion in Pennsylvania, he may find a thousand or more cards under the
heading "Education (History of)" but not classified further. There is
also the possibility that half a dozen cards have gone in under "Penn-
sylvania, Education in." Many important sections have been arranged,
and supplied with guide cards and cross-references — and the work is
going on — but it will probably be about three years before it will be
fairly complete. Absolutely complete it will never be, for such a
catalogue in a large growing library will always have some cards
wrongly headed, out of place, or obsolete. This last word "obsolete"
applies mainly to cards containing references to journal articles. When
a new subject of public interest comes up, such as the Spanish-American
war, or liquid air, or the Boers, a considerable number of journal arti-
cles are indexed for the immediate information of readers. In a year
or two, many of these have lost most of their interest, and when the new

CATALOGUE OF A GREAT PUBLIC LIBRARY

239

supplement to Poole's "Index" appears containing them, they are not
worth the space they occupy in the card catalogue, and should be re-
moved.

The question, "What shall be done in the way of analytical work?"
is one that is always under discussion in the catalogue department. The
numerous general and special encyclopaedias, year-books, directories,
almanacs, etc., which are essential in the reference department of a
large library often contain special articles, statistical tables, etc., which
are worth an index card, but the general rule is to rely on those in
charge at the readers' desk to point out these sources of information.
So long as there are a considerable number of books and pamphlets on
hand uncatalogued the decision usually is to defer analytical card mak-
ing until the separate works have been catalogued, if for no other
reason than to prevent the addition of duplicates, yet there are ex-
ceptions to this rule, the chief being the indexing of periodicals. As
an exception, take Schaff's "The creeds of Christendom," a valuable
reference book to be found in most libraries. The subject is so distinct
that it seems hardly worth while to make any analytical for the card
catalogue, and yet the reader who wants to see the text of the Heidelberg
catechism, or the "original confession" of the Society of Friends, or the
Savoy declaration of the Congregational churches may be very glad to find
in the catalogue a card telling him that what he wants is in Schaff's
"Creeds," and hence we have placed such cards there. The same argu-
ment, however, would apply to the list of "Churches in Manhattan and
the Bronx," the "Strength of the militia in the several states," the
"Population of the largest cities of the earth," the "Statistics of Amer-
ican college fraternities," and "The forty Immortals of the French
Academy," all of which are given in the World Almanac for 1901, but
which we do not index. The question as to whether analytical or
index cards shall be made is not usually "Are they worth making?"
but "Are they more worth making for this than for something else?"
Every number of a daily newspaper contains something that would be
of interest to some reader of the next century, even if it be only an
obituary notice, but it does not follow that every number of a newspaper
should be indexed or even preserved.

Some of the questions which arise in preparing the subject catalogue
may be indicated by the subdivisions which have been made for the
subject "Commerce," and the cross-references in connection therewith.
The first question is, Should the main subject word be "Commerce"
or "Trade"? "Trade" is the word used by Mr. Fortescue in his sub-
ject index for the British Museum, probably because he considers it
a more comprehensive term than "Commerce," which is usually un-

240

JOHN SHAW BILLINGS

derstood to refer to trade on a large scale, as between nations or com-
munities, rather than to what is called retail trade. We use the word
"Commerce" because 95 per cent, of our readers would search first under
that heading, and we place under "Business" the references to retail
trade. The second question is, Should works on the commerce of a
country or state be indicated under the name of that country primarily,
as is done by Cutter, Fortescue, and others, or under Commerce,
History of, regional or under Commerce, regional, by countries?

Another series of questions relates to cross-references, and especially
as to when a cross-reference is to be used in place of duplicating a card
for two subjects.

A book on the condition of the agricultural and commercial interests of
the United States might properly be referred to under both Agriculture
and Commerce, and also, perhaps, still more properly, under Free Trade,
but it will usually be sufficient to catalogue it under one subject only, re-
lying on cross-references from the others.

In this library a book is catalogued as to both author and subject be-
fore it is accessioned and receives a class mark. The result is that the
person who assigns the class mark has the benefit of the cataloguer's
opinion as to what the book is about, but sometimes he differs from this
opinion, and this may become a subject for discussion.

The following lists of headings used on the guide cards under
"Ireland" and "Shakespeare" will give a general idea of the sub-
divisions and cross-references adopted :

Fenianism, Ireland. See also Ireland, — History

Folk lore (Irish). See also Ireland, — Manners, Customs, etc.

Home rule, Ireland. See Ireland. — History 1873-1900

Ireland as author:
Government publications. (Public documents)

Ireland as subject:

Ireland.

— Bibliography (dated)

— Archaeology and antiquities. See also Ireland. — History, (Ancient); Lake dwellings,
— Ireland. Dolmans; Round towers; Wells (Holy)
Refer from Archaeology; Antiquities
— Census, (dated). See also Ireland, — Statistics; Statistics (Vital), Ireland
— Charities. See Charities, — Ireland; Poor laws, — Ireland (dated); Poor, — Ireland
— Commerce. See Commerce, — Ireland

— Description, — Scenery, — Travels, etc. (dated). See also Ireland, — Geography and
Guides; Ireland, — History (arranged chronologically)
Refer from Geography, — Ireland; Travels, — Ireland
— Economics. See Economics, — History, Ireland
— Ethnology. See Ethnology, — Ireland

— Finance. See Finance, — Ireland (dated); Money, — Ireland (dated)
—Gilds. See Gilds— Ireland

CATALOGUE OF A GREAT PUBLIC LIBRARY

241

—Geography and Guides. See also Ireland —Maps, (in Lenox)

Refer from Geography,— Ireland
—Government. See Ireland,— History arranged chronologically

» • • »

—Social life. See Ireland, — Manners, — Customs, etc.
—Statistics. See also Statistics (Vital), — Ireland

Refer from Statistics, — Census
— Taxation. See Taxation, — Ireland
— Topography. See Ireland, — Descriptions, etc.
— Travels. See Ireland, — Descriptions, etc.
— University question

— Vital Statistics. See Ireland, Census; Vital Statistics, — Ireland
Shakespeare (William)
Bibliography.
[Works by him]
Collected works, dated
Single plays
Doubtful plays
Poems
Sonnets
Selections
[Works about him]
Shakespeare, William
as an archer
Bacon question
and the Bible

Biography and Personalia. See also Shakespeare (Portraits of)
(Botany in)
Celebrations
(Comedies of)

Commentaries and criticism. (Commentaries and criticism on a single play

follow its text.)
Concordances
(Contemporaries of)
as a dramatist
(Emblems in)
(England of)
(Ethics of)
(Euphuisms in)
(Folklore in)
in France
in Germany
(Ghosts in)
(Grammar of)
(History in)

(Home of) See also Shakespeare — Biography and Personalia; Shakespeare —
(England of)

• * # #

The subdivision of labor which is necessary in a large library gives
to some extent the usual unsatisfactory result of such subdivision in

242

JOHN SHAW BILLINGS

that most members of the staff become thoroughly familiar with only a
part of the work. Those engaged at the readers' desk rely more on their
knowledge of the books than on the catalogue, to which they resort only
in case of necessity, and require some time to become familiar with it.
They see all the new books as they go through to the shelves, but not
all the old ones. On the other hand those who assign subject headings
to the cards are not always as familiar with the form in which readers'
queries are put as they should be. We try to remedy this by having the
classifiers take turns at the readers' desk, and by carefully noting the
complaints of readers about the catalogue, and trying to do away with
the causes for such complaints, and no doubt with time many of
the difficulties will be minimized or entirely removed.

The space occupied by a large card catalogue is a matter that re-
quires careful consideration and sufficient provision. In the new
library building on Fifth avenue the public catalogue will be in a room
78 x 85, through which it is necessary to pass to enter the main reading
rooms. In this room provision will be made at first for cases to contain
two and one half millions of cards, and there will be space for cases
for two and one half millions more. These cases have corresponding
tables on which the single drawers of cards can be placed when in use.
These will provide for a catalogue of about 1,500,000 books — and
when this limit is reached an extension of the building will be ur-
gently needed.

When the libraries are moved into the new building there will
probably be 800,000 books and pamphlets to be stored in it, requiring
a public catalogue of about two million cards. I do not venture to
prophesy much about the details of arrangement of this catalogue, but
these are some of my hopes:

1. That it will contain an author card for every book and pamphlet
in the building, showing its location. This includes the books in the
lending part of the library.

2. That it will contain one or more subject cards for every book in
the reference library not catalogued by subject in the special catalogues
connected with the special collections having separate rooms, such as
of maps, music, manuscripts, incunabula, public documents, sociology,
Jewish collection, Oriental Collection, Bibles, genealogy, etc., and also
for the most important books in these special libraries.

3. That it will also contain subject cards giving references to impor-
tant articles in periodicals and transactions for the last ten years so far
as these are not obsolete or contained in special card catalogues in other
parts of the building.

4. That in this room, or near it, will be a collection of catalogues of

CATALOGUE OF A GREAT PUBLIC LIBRARY

243

other libraries, including that of the British Museum and of the Bibilo-
theque Nationale of Paris (printed) and a card catalogue of authors of
the books in the Library or Congress.

5. That near the center of this catalogue room there will be an
information desk at which a librarian with assistant will be ready to
assist readers, show them how to use the catalogue and see that their
order slips are correct before they go to the delivery desk. The latest
accessions to the library may be at this information desk.

6. There will also be in this room tables and seats for about 25 readers,
and about 5000 volumes of reference books on open shelves.

7. That in the special reading rooms in the building, devoted to
special subjects, there will be special card catalogues and bibliograph-
ical works related to those subjects, that in most of these rooms the
books will be on open shelves and freely accessible to the readers, and
there will also be a person in charge of the room competent to assist
students in that particular branch.

Supposing that all this is accomplished with not more than the average
proportion of errors and shortcomings, how will the result compare —
from the reader's point of view — with such a card catalogue as the
"repertory" at the International Institute of Bibliography at Brussels
(described by Mr. Bowker in the Library Journal for June, 1900, p. 273),
which already contains over 3,000,000 titles?

It is probable that about 99 per cent, of those who consult the New
York Public Library would never use such a "repertory" so long as the
library catalogue was available. The reason is that in the great majority
of cases the library catalogue would indicate enough sources of informa-
tion to satisfy the wants of the inquirer, and he would know that all
these sources of information are in the library, and know by what marks
to call for them. If he were to consult the "repertory" his work of
search would only be begun after he had copied the titles he desired,
for he would then have to find out whether they are in any accessible
library.

If a bibliography is a critical or annotated one, showing for each
title given whether the book has any special value, or contains anything
not to be found in other books, the search might give results worth the
trouble, but without such notes or indication of location a long list
of titles of books, pamphlets, and journal articles is simply dis-
couraging to the average reader. Fancy being confronted with six
thousand titles about Aristotle, or ten thousand titles about ordination
sermons, or two thousand titles on the duties of parents, or eleven
thousand titles on labor and capital, from which to select more or
less blindly those which may have some interest in connection with the

244

JOHN SHAW BILLINGS

question at issue, and then to be compelled to find out where they arel
The bibliography of New York colonial history, recently published by
the New York State Library, has its value greatly increased by the fact
that it indicates where the books may be found.

The most important objection to an alphabetical index catalogue such
as that described, is, that it often separates widely the lists pertaining
to closely allied subjects, as for example, food, butter, cookery, milk,
etc., and while the guide cards for the general subjects will give refer-
ences to other subjects for details, the student who wishes to find all that
the library contains on some rather general subject would prefer to have
the catalogue arranged by classes as far as possible.

This objection will be obviated to some extent by the shelf lists which
will be prepared in accordance with the new classification, and which
will be available for the use of readers, but these shelf lists will not be
made until we move into the new building, and the books now
divided between the Astor and Lenox buildings can be arranged to-
gether. Moreover a shelf list can never take the place of a subject list,
because for every subject there are important pamphlets and articles
in transactions and periodicals to which the shelf list gives no clue.

One of the questions which arises in the arrangement of the subject
cards in a large catalogue like this, is, as to whether in certain subjects,
and especially in historical groups, the arrangement should be chrono-
logical or alphabetical. Some readers prefer the first, others the second.
The alphabetical arrangement is more convenient for the librarian
in checking off lists of books on a certain subject in order to see what the
library has, or has not, and it is also usually preferred by the casual
reader, who is more accustomed to it, while the chronological order is
preferred by the systematic student, and by the reader who wishes to
refer to the latest work, or to the oldest work, with the least possible
delay. At present we are arranging the cards of titles relating to the his-
tory of countries in chronological order, and the same plan has been
followed in some of the sciences, such as mathematics, but as yet in
many subjects the cards are in alphabetical order, which is easiest for
the filers. The general tendency is to use the chronological arrangement
for those subjects which are most likely to be studied historically, either
as regards their own origin and development, or as throwing side
lights on general history as, for example, Banking, Commerce, Finance,
Taxation, Poor laws, etc., but for nearly all such subjects the chronologi-
cal arrangement is subordinate to that by country.

In conclusion I would say that twenty-five years ago I held much
more definite and positive opinions as to how an index catalogue like
that of the New York Public Library should be arranged than I do at
present.

Address at the Dedication of the New
Building of the Boston Medical
Library, January 12, 1901

No doubt we have all heard "platform figureheads" — of advanced
years and much experience — commence their remarks on occasions like
this by saying that one of the privileges of old age is the perspective,
restrospective view which it gives of institutions, society and the world
in general. I used to suppose that this was an excuse for, and explana-
tion of, the attitude of sage and prophet assumed by the speaker, and
that he enjoyed solid comfort in giving advice; but I am now begin-
ning to appreciate how those old gentlemen really felt when they
announced this important discovery. Most of them, I think, did not feel
as wise as they looked, nor as certain and free from doubt as they did
in their youth, but circumstance compelled them to speak, and this was
a way to begin.

As I look back to the ceremonies of opening the then new building
for this library in Boylston Place in 1878, I find that of the speakers on
that occasion, I am the only one now present. President Eliot is still
very much alive, although not here tonight; but Holmes, Ellis, Lyman,
Smith, Henry I. Bowditch and Justin Winsor have passed away, and
their biographies have been written. Fortunately, the results of their
work remain and are enlarging, and one of these results we have before
us tonight.

The medical prospect has changed somewhat within the last twenty-
two years; there is a new literature, a new pathology, a new surgery,
and new names for some very old things, — Christian Science, for example,
— but the old records have not lost all interest, and the special value
of the library is that it contains both the old and the new. In his
memorable address twenty-two years ago, Dr. Holmes rightly insisted
that a library like this must exercise the largest hospitality, but this
applies to gifts rather than to purchases. The funds for conducting a
library, medical or other, are always insufficient, and the librarian, or
library committee, must therefore exclude from the purchase lists many
works which might be welcome additions if obtainable from other
sources. The selection is sometimes difficult, and in making it, the work
of other reference libraries in the vicinity, such as the public library, the

Boston Medical and Surgical Journal 144: 61-3 (1901).

245

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JOHN SHAW BILLINGS

university library, and some special libraries, must be considered. Even
gifts must be scrutinized with reference to available space, and to their
relative utility in other neighboring institutions. This library does not
want a set of United States public documents, or of Massachusetts docu-
ments, although in each of these series there are a few things which it
should secure. Curious things may be found in public documents. How
many of you, I wonder, have ever heard of Herkimer Sternberg, and his
great medical discovery, which is vaguely indicated in the following extract
from Document No. 15 of the Assembly of the State of New York, dated
January 15, 1859, being a report of the Committee on Medical Societies
and Colleges, relative to the petition of Herkimer Sternberg for aid in
publishing his manuscript of a proposed work. The committee reports
"that they have had under their serious consideration the subject referred
to them and have become satisfied if the prayer of the petitioner be granted,
that the result of the scheme proposed by this Herkimer Sternberg, if suc-
cessful, will be the annihilation of the medical profession, and thus the five
or six thousand doctors of our State will be turned out upon the cold
charities of an unfeeling world; that it will introduce the millennium sev-
eral years before its proper advent in the regular order of business; that it
will dislocate every joint in the system of the moral universe . . . and,
therefore, the committee ask to be discharged from its further consider-
ation."

In cities where there is no medical library, it is clearly the duty of
the public library to provide some of the best medical books and
periodicals for the use of the physicians of the city, as well as for the
direct benefit of the public. It, is however, a matter of common expe-
rience that some lay readers are rather injured than benefited by reading
medicine, and that it is best to restrict the use of certain classes of
medical books. It simplifies the problems of the librarian of the public
library when he knows that there is in the city a special medical library
available for the use of physicians, and that he need only obtain
those books which, if not exactly suitable for public use, are not calcu-
lated to do much harm. He will usually be glad to send to such a
medical library the medical books of the eighteenth and most of the
nineteenth century, old medical journals, miscellaneous medical pam-
phlets, theses, reports, etc., and to retain in the public library only
those which have some interest in local history, or in other subjects
besides medicine.

There are certain duties and responsibilities which rest upon a few
large reference libraries which do not pertain to the great majority of
city public libraries. For example, the average city library should collect
and preserve all the reports of hospitals in its own city as a matter of
local history, but it should not waste time or energy over the reports

ADDRESS AT BOSTON MEDICAL LIBRARY

247

of hospitals in other cities, but should send those that come in either to
a medical library or to one of the great reference libraries of the country
like the Boston Public, the New York Public, or the Congressional
Library. These great libraries must collect and preserve such reports
as a part of their collections relating to charities — private and public —
an important branch of sociology, but they are only useful in this way
when the collections are very large and permit of comparisons of
methods and results from a wide area and for considerable periods of
time.

The field of medicine is very broad, and the special medical library
might properly include not only general biology with its general
subdivisions of morphology, physiology, psychology and anthropology,
but also much of the literature of botany, zoology, chemistry, physics,
municipal engineering, building and other applied sciences — and in
fact the great medical libraries of London, Paris, Berlin, St. Petersburg
and Washington do include many of these subjects. But this requires
more space and money than most medical libraries can afford to give,
and hence it is usually best to leave most of these subjects to other
special libraries.

The department of first importance in a library like this is that
which contains its files of periodicals, not only because they contain the
original records from which textbooks and monographs are made up,
but they represent the feelings, views and wants of the great mass of
the profession, and are the great sources for the medical history of the
nineteenth century. Medicine is now the most cosmopolitan and inter-
national of all the arts and professions, and this is largely due to its
periodicals. Moreover, its periodical literature is now more accessible
than that of any other profession because of the indexes upon which
Dr. Holmes so much insisted. All this has been fully recognized by
your librarian, and you are very rich in this class of literature. Thanks
to the efforts of the medical profession of Boston (aided by those of
some other parts of the country), Congress was induced to order the
printing of the Index Catalogue of the Washington Collection which
was under consideration twenty-two years ago, and which I then thought
might make six volumes. This Index Catalogue is not yet finished, only
twenty volumes having been published; but it can give considerable
employment to the bibliographical student even now, and has probably
added to the practical utility of this library, but perhaps not always
to the perfect joy and content of its readers.

The fact that the physicians of Boston have another library besides
this one to care for, as shown by their action with regard to the Index
Catalogue, is one that I venture to remind you of because the needs
of your National Medical Library are liable to be overlooked. Just now

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JOHN SHAW BILLINGS

it is in urgent need of shelving for its additions, some of which are
being stored in window sills or on the floor, which is bad for the
books and for the readers.

Requests for funds to provide this shelving have been presented at the
last two sessions of Congress, but received no attention. An estimate
is before the present Congress for $9,000 to supply this shelving, and
if the Massachusetts representatives and senators hear from their medi-
cal constituents that this is a matter in which they are interested, there
is no doubt that it will be done. Your Washington Medical Library
now contains 136,000 volumes and 230,000 pamphlets — decidedly the
largest and best library of its kind in the world — and ought to be kept
up to date in good shape.

When I tried to say something on the occasion of the opening of this
library in the Boylston Place Building, I well remember that I was
very much embarrassed and not a little afraid, and would have been
very glad to have been merely a listener.

On the present occasion, while I am in trouble to find the right words
in which to express my thoughts and feelings, I am very glad indeed to
have the opportunity to congratulate you upon the result of the work
of the Boston Medical Library Association during the last twenty-five
years, and I do congratulate you most heartily and sincerely. The collec-
tion of books, of portraits, of medals, the building in its plan, structure
and furnishings, are all things of which you have good right to be
proud, and with which you may rest satisfied for several weeks to come.

As you all know, these results are largely due to the fact that one man
having abundance of energy and public spirit, with much knowledge
and an insatiable thirst for more, and with a fairly definite idea of
what he wanted, has been working incessantly for the last quarter of a
century towards this end. I congratulate you upon your wisdom in
letting him thus work, and in helping him to carry out this plan. His
power for good has not been limited to Boston, for by way of recreation
he has devoted some of his time to stirring up and stimulating other li-
brarians like myself, when he thought they needed it, or when he had
some superfluous energy to dispose of, which was often. In this and other
ways, he has given material and valuable assistance to other libraries,
more than any of you are aware of, and it is not my personal affection for
him, great as that is, but a sense of what is just and right, which leads
me to say to you that, while the Boston Medical Library has been his
special pet, for which no trouble was too great to take, and no sacrifice too
great to make, all other medical libraries in this country are more or less
indebted for their progress and prosperity to your librarian, Dr. James R.
Chadwick.

Some Library Problems of To-Morrow

When the American Library Association was organized its object was
declared to be "to promote the library interests of the country by ex-
changing views, reaching conclusions, and inducing co-operation in all
departments of bibliothecal science and economy; by disposing the pub-
lic mind to the founding and improving of libraries, and by cultivating
good will among its members." When the Constitution was revised in
1900, the object of the Association was declared to be "to promote the
welfare of libraries in America."

This change is significant, not of a change in the purposes of the Asso-
ciation, but of a general opinion that verbose details of its purposes
are now unnecessary. At first the Association undertook much direct
missionary work, but this has gradually been taken in charge by state
and local associations to such an extent that our work in this direction is
now mainly to obtain records of the methods which have been found
most successful, and to bring these to the attention of those directly
engaged in interesting the people at large, and legislators and tax-payers
in particular, in the establishment and support of free public libraries.

It is the welfare of the free public library, and especially the library
intended mainly for the circulation of books for home use among the
people, and supported from public funds, to which we have given the
most attention. This is especially an American institution and it has
seemed more important that its uses and needs should be understood
and appreciated by the general public than those of purely reference
libraries, since these last are fairly well understood by those who most
need and use them.

The main argument in favor of the free public library is that it is an
essential part of a system of free public instruction which is a necessary
foundation of a satisfactory system of self government. It is not true,
however, that any and every system of education tends to produce a
stable democracy, and there are great differences of opinion among pro-
fessional educators, and still greater differences of opinion among
other thinking men who know something of the methods and results of
our public schools, as to whether our present system is the best one. If
the main object of the school and of the teacher is to furnish informa
tion and cultivate the memory, there is good ground for objecting tc
both the quantity and quality of some of the kinds of information

Presidents's address to the American Library Association, June 17, 1902. Library
Journal 27, no. 7: 1-9 (1902).

249

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JOHN SHAW BILLINGS

supplied. If the object of education is to develop the intellect, to teach
the student how to judge as to what is true and to know where to look
for it, to recognize wise thought, and to distinguish the man who is
qualified to lead from the incompetent man who wants to lead, then our
public school system is not well suited to its purpose.

The relations which should exist between the system of public librar-
ies and the system of public schools in a State or city are not yet
generally agreed upon by both librarians and teachers. In a general
way it may be said that the librarian's view is that the public library
should be entirely independent of the public school system as re-
gards its funds and management, that special school libraries are apt to
be badly managed, and inefficient for the purpose of interesting and
instructing the children, that the librarian knows more about books
than the teacher, and can supplement and broaden the teacher's work:
— and that teachers should recognize these facts, should be willing and
anxious to receive instruction and advice from librarians by listening to
lectures and talks at the library and repeating to their classes what they
have been taught, and urging the children to make use of the library.

A few enthusiasts claim that the librarian ought to know more than
any teacher, and should supplement the defects and ignorance of each
instructor in his own branch, but treat them all kindly and tactfully,
recognizing that it is not their fault that they do not know as much as
librarians. Some librarians admit that some teachers may know more
than they do as to the reading most desirable to supplement the partic-
ular instruction which a class is receiving, and will be glad to receive
lists of books wanted. All librarians think it very important that the
child should learn to use the public library and become acquainted with
its attractions, methods, and resources, so that after leaving school he
will continue to use it, and they do not consider that any mere school
or class library can be a satisfactory substitute for the public library.
Moreover, they want the children to come to the public library and use
it because this is a means of bringing their parents and friends under
the same influence.

Superintendents of schools, as a rule, take a somewhat different view
of the matter, that is, if they have given any thought to it, but I am
bound to say that many of them reply to questions on the subject, that
they have never given it any special consideration. Some of those
who have considered the matter say that, of course, the public library
is a useful institution, that its chief use is educational, that it should
be managed so as to help the public school as much as possible, but that
it should not interfere with school methods. They believe that the
school should have a library of its own, under its own management, selected

SOME LIBRARY PROBLEMS OF TOMORROW

251

with reference to the needs of the different classes and grades, that the
teachers should see that the children use these books, and have a record of
such use as a guide to dealing in the best way with the individual child.
They say that the public library, in its recent arrangements for attracting
children and especially those in the lower grades, tends to interfere with the
school plans for reading, that the children find in the library much that
is more attractive than the books which they can find in the school
library, but which is also less useful; that they acquire the habit of
desultory reading, and are led off from the proper course. The junior
teachers in the schools in our larger cities stand in somewhat the same
relation to the superintendents that the junior assistants in the public
library stand to the librarian, and the opinions of each, while interesting,
are not conclusive. At present the majority of teachers in the lower grades
know and care very little about the public libraries; they may use them
to obtain current fiction, but it seldom occurs to them to take their
classes to them or to tell the children what they can find there.

At present it appears that the librarians are more aggressive, energetic,
and filled with the missionary and proselytizing spirit than are the
teachers, possibly because the work of the latter is more monotonous
and fatiguing.

I have several times been asked by legislators and jurists whether the
public schools and the public libraries could not wisely be consoli-
dated under one central management and thus be made to work har-
moniously.

It is theoretically possible, but I think that the result would be that
the libraries would lose much, the schools gain very little, and the
public at large be profoundly dissatisfied.

The Library Association has a special committee on co-operation with
the Library Department of the National Educational Association, and
it is to be hoped that this committee will find a satisfactory solution
to the problems connected with the relationship of the library to the
school. No hard and fast rules can be established, but it would seem
that the library, supported by public funds, should not interfere with
the work of the public school. On the other hand, one of the most im-
portant functions of the school is to train the children to use books
and libraries, and at the present time the chief obstacle to the proper
performance of this function is that the teachers themselves are in
great need of instruction about public libraries and how to use them.
For the great majority of children story books and works on general
literature of the right kind are not only more interesting but more impor-
tant means of education than the average textbooks.

The class which, at present, far outnumbers all other classes in this

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JOHN SHAW BILLINGS

country is, as Professor Bryce says, the group of "thinly educated persons
whose book knowledge is drawn from dry manuals in mechanically
taught elementary schools, and who in after life read nothing but
newspapers or cheap novels." 1

Those who have had practical experience in free circulating libraries
know the truth of this characterization, and are trying to get the children
interested in the library as early as possible; if the library proves more
attractive than the school it is quite possible that the school methods
should be changed. But whatever may be thought of elective studies
in the high school and college course, the public library system of
instruction must necessarily be largely elective; and mere amusement
should not be the leading elective, as seems to be too often the case.

In recent years the subject of co-operation between libraries and
librarians has been one to which much thought has been given and
for which a great number of plans have been proposed. To secure the
most useful co-operation, it is desirable to bring into the work many
libraries which are not intended for the circulation of books, except,
perhaps, among a limited class and some of which are not supported
by public funds. These include the libraries belonging to the general
government and to the states, university libraries, and the larger li-
braries belonging to and managed by private corporations, either as refer-
ence libraries only, but for the use of the general public, or as reference and
lending libraries for the use of members, stockholders, or subscribers only.
Among these are many scientific, historical, and technical libraries.

The problems of these reference libraries have been receiving in-
creasing attention in the Association in recent years, as is shown by the
organization of a section devoted more especially to their work, and
the subject of co-operation will come up for discussion at this meeting
in several ways, and will, no doubt, be considered from several different
points of view. The question, as it appears to most libraries, is, What can
the greater libraries do for us in the way of cataloguing, bibliography,
lending of books, etc., with the tacit assumption that whatever they
can do, they ought to do.

It does not seem necessary to produce arguments in favor of this
view, but perhaps a suggestion that the smaller libraries should, on their
side, assist the larger ones so far as they can, may not be out of place.

The public library in this country, which now stands, or should
stand, second, if not first, in interest to every librarian is the Library
of Congress. I feel it to be a duty as well as a pleasure to report to you
that the work of this library is being well done, and that Congress has

1 James Bryce, Studies in history and jurisprudence. N.Y., 1901, p. 200.

SOME LIBRARY PROBLEMS OF TOMORROW

253

recognized the wisdom and tact of its librarian by increased appropri-
ations for books and for service. You are all familiar with the work
being done by this central library for other libraries throughout the
country by furnishing catalogue cards, bibliographical data, etc. I think
it well, however, to remind you of your duties to this your National
Library, and especially that the librarian of every city, town, or village
in the country, should make it his or her business to see that one
copy of every local, noncopyrighted imprint, including all municipal
reports and documents, all reports of local institutions, and all ad-
dresses, accounts of ceremonies, etc., which are not copyrighted and
do not come into the book trade, is promptly sent to our National
Library.

I cannot speak so positively and definitely about the state libraries
or the great reference libraries of the country, but most of them will
be glad to receive such local publications as I have indicated, and the
New York Public Library especially desires assistance of this kind.

The controversy between the individualists and the collectivists which
is going on in many fields of human activity exists also among those
interested in library organization and management and is taking much
the same course there as in commerce and manufactures. The tendency
is towards organization and division of labor, at first by co-operation,
later by consolidation. The free public library is tending to become a
special industry by unification of methods for the purpose of securing
the greatest product with the least expenditure. The general public,
and many librarians, think that the measure of greatest product is the
number of books circulated. This is the argument used with city
officials to secure increased appropriations, and the kind of books which
will circulate most rapidly and the methods of advertising which will
increase the numbers of readers are matters of much interest to library
trustees and managers. From this commercial point of view much re-
mains to be done in the way of co-operation. It is probable that the
co-operative cataloguing now under way could be much facilitated,
and a considerable saving to individual libraries effected if one small
committee of experts selected all the books to be purchased for each
and every library. These books could then be catalogued, with annota-
tions on the most elaborate plan, classed, marked, and delivered to the
several libraries, where, in course, they would go on open shelves and
be advertised by co-operative short lists. The libraries could then dis-
charge most of their cataloguers and experts. One-half the money now
used for salaries could be devoted to buying books, the circulation
would increase and the business would flourish.

Moreover, this committee of experts for the selection of books to be

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JOHN SHAW BILLINGS

purchased would naturally be consulted by publishers as to what partic-
ular varieties of literature are most in demand. It would suggest sub-
jects and writers, read MSS. and indicate the pictures which would stim-
ulate the circulation of the volume, and not be objectionable to any
one. From this, it would be an easy step to undertake the publi-
cation of books for free public libraries and thus effect a wonderful
reduction in cost; and if the librarians take up the business of book-
selling the scheme will be still more neat and compact.

I need not go into further details, or show what might be effected
for the world's progress by simply extending this scheme to an inter-
national system; no doubt you can all readily imagine the results which
might be obtained by a great cosmopolitan free circulating library trust
with the latest attachments and improvements. We should then have
accomplished an important part, what some consider the most impor-
tant part, of the original object of the Association, which, you will
remember, was declared to be the "reaching conclusions and inducing
co-operation in all departments of bibliothecal science and economy."
Of course, in the formation of the expert Board of Managers, the de-
mand for representation which will be made by the leaders and mana-
gers of different religious, political, and sociological sects and parties
would require consideration, and there are some other important
details to be considered by the Committee on Co-operation when it takes
up this part of its work.

I do not think there is any immediate prospect of the formation of
such a free public library trust as I have indicated, or that the cheapen-
ing of library service in this way is desirable, even if it were possible,
but there are many things in the mechanical details of library economy
in which co-operative work may be of service without checking or
interfering with individual development.

Circulating libraries supported from public funds will naturally tend
to greater uniformity in methods and scope than reference libraries
supported by corporations, but each has something to learn from the
other.

There are some men — and women — who have a great desire for
uniformity, who think there is only one best way; they want codes,
and rules, and creeds; they want all schools and high schools and uni-
versities to have one system, even to the periods of their vacations;
they want a rule about fiction, and about classification, and about salaries
for all libraries, and they want resolutions passed about all these things.

Concentration has its evils as well as its advantages. Some excellent
library work in our large cities is done by institutions or societies which
use the library as a means to secure attention to their special end,

SOME LIBRARY PROBLEMS OF TOMORROW

255

which may be religious, sectarian, humanitarian, or sociological. The
friendly rivalry of different libraries in the same city often has good
results, though perhaps it may be a little wasteful of money. To
secure the use of a library, the energy and enthusiasm of a propagan-
dist are very useful, but the propagandist does not work to the best
advantage in a systematic hierarchy. It is the old question of the
individual worker or dealer versus the co-operative, or the consolidated
establishment, and while the ultimate answer may be in favor of the
latter as giving the greatest amount of useful results with the least ex-
penditure of force, we can understand the feelings of the individual
worker who fears that he will be crowded out, and who says that
"the lion and the lamb may lie down together, but the same lamb
don't do it again."

It must be remembered that almost every change in the manner of
doing things is injurious to some individuals. Evolution affects not only
the fittest, but also the unfit. If it be true that the public library is
injuring the business of the bookseller, that the hustling administrator
is crowding out the scholar in library positions, and that old-fashioned
readers find their old resorts in the libraries less comfortable because
of the crowd which now frequents them, it may still be true that the
general result is satisfactory.

The question as to whether the public library shall undertake to
do other work for the public benefit besides the supplying of literature
has occasionally been raised, but has not been seriously discussed
as a general proposition. When Mr. Carnegie's offer to provide
branch library buildings for the city of New York was made public,
many suggestions were made as to the desirability of making these
buildings something more than libraries. For example, it was advised
that they should be made social centres and substitutes for the saloon,
that they should have lecture rooms, rooms for playing various kinds
of games, smoking rooms, and billiard rooms, and even public baths
in the basement were recommended. At the present time, in a large
and crowded city, the need and demand for public library facilities
is so great that it has seemed best to confine the work of these build-
ings to library work proper, but in more scattered communities,
where sites are not so costly, and meeting-rooms less easy to be obtained,
some of these suggestions are worthy of careful consideration, and it
might be well to collect the experience of the members of the Associ-
ation bearing on this question, and make it a subject for discussion at a
future meeting.

As usual, during the past year, there have been some public ex-
pressions of doubt as to the utility or expediency of circulating libraries.

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Mr. Howells suggests that we may be in danger of reading too much,
"reading to stupidity." Lord Rosebery also warns us to beware lest much
reading should destroy independence of thought, referring to the "im-
mense fens of stagnant literature which can produce nothing but intel-
lectual malaria." Of course, in some particular cases reading does
produce bad results. It would, no doubt, be better for the public in
general, and for their own families in particular, if some men and
some women had never learned to read. "On a barren rock weeds do
not grow — but neither does grass." It might also be better for the world
if some sickly, deformed, degenerate children did not live, and the
jail fevers of the eighteenth century probably disposed of some crimi-
nals to the best advantage; nevertheless it has been found to be wise
economy to spend considerable sums of money in lessening the mor-
tality of infants, and of jails, in the inspection and regulation of
tenement houses, and in the compulsory restraint of contagious diseases,
because the majority of the lives thus saved are worth saving, and they
cannot be saved without preserving some others who from the mere
utilitarian point of view may not be worth the cost.

The expenditure of public funds upon free libraries is in like manner
justified by the general belief that it will do more good than harm.
We cannot yet furnish satisfactory statistical evidence as to the results
of the free public library experiments which we are trying on a large
scale; there does not yet seem to be any marked decrease in crime or
increase in contentment among the people who have had most use of
such libraries, and, while the physical welfare of the great mass of
the people has been advanced during the last fifty years, it would be
difficult to trace this to the free public library because we do not know
what use of such libraries has been made by the few hundred inven-
tors and captains of industry to whom this progress is mainly due.

It does seem, however, that the free public library has lessened the
power of the demagogue and unscrupulous politician to control votes,
and that in public life the steadily increasing influence of educated
men is, in part, due to the reading facilities which the people now
enjoy.

When the author of Ecclesiasticus2 declared that he that holdeth the
plow, the carpenter and the workmaster, the smith also sitting by the
anvil and considering the iron work, and the potter turning the wheel
about, all these trust to their hands, without them cannot a city be
inhabited, — they shall not be sought for in public counsel, they shall not
sit on the judge's seat, and they shall not be found where parables are

2 Ecclesiasticus, xxxviii, 25-34.

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257

spoken, but they will maintain the state of the world, he did not foresee
the effect of a system of public education including free public libraries,
in a democratic government.

As regards Mr. Howells' suggestion about "reading to stupidity,"
that is precisely the object of many of the readers of current fiction.
They are tired and worried, and they read to forget or to get asleep.
The average novel will give this result in from six to ten minutes,
and the after effects are not nearly so bad as those of chloral or sulfonal.
The novels of five or six years ago will answer this purpose just as
well, and twelve new novels a year is an ample allowance for the average
free public library. But five-sixths of the other books which are pro-
duced— not because the author had anything to say, but because the
publisher thought that a book on the beauties of brooks, or on the
birds' nests of the Bronx, or on the homes of historical stepmothers or
on the lieutenant colonels of the Revolution, would sell well — are
usually of little more value in the free public library than the novel;
they count for circulation, but they are not read, but merely glanced
over — mainly for the pictures.

At the present time public opinion in this country tolerates expres-
sions of great differences of opinion with regard to religion and partic-
ular creeds. Recently a few Catholics have made objections to the
free public library, upon much the same grounds as those upon which
the Church objects to public schools, and demand that in both the
school and the library the books provided shall be subject, directly
or indirectly, to their censorship. Somewhat similar demands, although
not so definite and systematic, are occasionally made in behalf of other
sects, and they would no doubt come from a number of other religious
and political organizations if it was supposed that there was any
chance of their success. The question will usually be decided for each
locality by political party requirements, which vary much at short in-
tervals, and there is no immediate danger to the free public library
system from this particular form of opposition, except possibly for a
short time in some limited locality. It is necessary to bear in mind, how-
ever, that public opinion is much less tolerant in matters of morals and
manners than it is in matters of religion, and that in selecting books for
circulation this opinion should be considered and respected.

The librarian of the free public library has, as a citizen, the same
rights and duties as any other citizen, including the right to express
his opinions on religious or political questions, but as a general rule,
his influence for good will be greatest when he is not a partisan of
any particular policy of either church or state.

As regards the large reference libraries, the selection of books must

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be made much broader in scope, for even the most ardent propo-
gandist of a particular creed or shade of opinion occasionally wants to
see what his opponents are saying in order that he may specify their
errors, and does not object to find their publications in the reference
library, provided they are carefully put away for the use of experts
like himself and are not placed on open shelves consulted by the
general public.

The duties and problems of our great reference libraries are in many
respects peculiar, but the limits of this address permit of only a brief
reference to some of them. One of their duties is to preserve the litera-
ture of the day for the use of future scholars and students. Part of the
business of the circulating library is to have its books worn out and
destroyed in actual service, but the reference library has also another pur-
pose, and the books which give it the greatest value and importance should
be carefully preserved.

The relations which should exist between our great reference li-
braries located in large cities and the rapidly multiplying smaller
libraries scattered all over the country merit careful consideration. The
amount of public funds which can and should be devoted to public
libraries is limited, and these funds should not be employed in doing
comparatively unnecessary work. Many of the smaller libraries are now,
or soon will be, complaining of want of shelf room, and are at the
same time accepting and trying to preserve and catalogue everything
that comes to them. All of them are preserving books that will not be
used by any reader once in five years, and two or three copies of which
in the large central reference libraries will be quite sufficient for
the needs of the whole country. The remark of President Eliot in
his last annual report that "the increasing rate at which large col-
lections of books grow suggests strongly that some new policy is
needed concerning the storage of these immense masses of printed
matter" is very suggestive; and his idea that if the Congressional Library
and the great reference libraries in a few of our largest cities would
undertake to store any and all books turned over to them and make
them accessible to scholars in all parts of the country, the functions of
the other libraries might be considerably amplified, is no doubt a
true one.

Whether the great reference libraries could undertake the work thus
indicated would depend upon the construction placed on the require-
ment that all books should be made accessible to scholars in all parts
of the country. Whether the other libraries would be disposed to
accept the suggestion to turn over their old books not in immediate
use, merely because it might seem for the public good so to do, is

SOME LIBRARY PROBLEMS OF TOMORROW

259

much more doubtful, and the selection of the useless books involves
some questions which would be good topics for discussion in the
trustees' section of this association.

It is always possible to show that any book or pamphlet, in any
edition, might be called for by some reader, student, or professor if
he knew it existed, and the difficulties in selecting books to be discarded
are very considerable. Mrs. Toodles' state of mind about things that it
might be handy to have in the house is one that librarians well under-
stand. It is no doubt true that in the great majority of libraries of one
hundred thousand volumes and upwards, one-fifth of the books are so
little used that it would be wiser to dispose of them than to use a
fund available for salaries or for the purchase of books for providing
additional room. Just at present, in most communities, it seems easier
to obtain funds for library buildings than it is to get the means to
ensure good service.

Closely connected with this is the question as to the acceptance of
gifts of books, especially when made with the condition that they are
to be kept together to form a permanent memorial for the donor. While
each case must be decided on its individual merits, it may be said
in general that the desire for a memorial can be fully met by book-
plates and catalogues without the unfortunate and unwise requirement
that a certain group of books must always be kept together. Even
gifts without restrictions, consisting of one or more cartloads of mis-
cellaneous public documents, odd numbers of periodials, imperfect files
of newspapers, pamphlets of little interest, etc., involve some expense
to the library, and very few libraries should try to retain and utilize
more than a small part of such material.

General discussion as to what large reference libraries should do is
of very little practical interest. The interesting question is, "What
should this particular library do?"

Should the Library of Congress obtain and preserve complete files
of every newspaper published in North and South America?

Should the Boston Public Library try to obtain complete sets of the
public documents of the Southern States?

Should the New York Public Library complete its collection of first
editions of American Authors by purchase at current prices?

Should the New York State Library try to make a complete collection
in Genealogy?

Should the Chicago libraries attempt to make a complete collection
of the reports of Insane Asylums?

There are many questions like these which require a knowledge not
only of the present contents, the available funds, and the special needs

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of each library, but also a knowledge of what other libraries are doing,
if proper answers are to be given.

The methods of co-operation between the great reference libraries,
for the public good and for mutual benefit, are as yet rather local and
rudimentary. Some points of agreement have been reached between the
Congressional Library, the Boston Public Library, and the New York
Public Library, as to the purchase of certain manuscripts and rare books;
and in every large city there is more or less co-operation between the
greater reference libraries, including the University library, as to pur-
chases,— especially of periodicals. The chief subject thus far considered
by them is that of Bibliography.

Many schemes for bibliographies, general, special, annotated, etc.,
have been suggested, and a few have been or are being tried. Each of
these, from the universal bibliography to contain thirty millions of
titles, to the bibliography of posters or of Podunk imprints, or of
poems and essays condemned by their authors, has at least one admirer
and advocate in the person who would like to have charge of the
making of it; but when it comes to the question as to what has a com-
mercial value there is great unanimity in the opinion that many of
those bibliographies should be paid for, not by the makers or the users,
but by government or by some philanthropic individual.

A bibliography is very instructive and useful to the person who
makes it, and it is well to give the person having a taste for such work
as ample facilities as possible; but mere uncritical lists of all the books
and journal articles relating to a given subject, from the commence-
ment of printing to the present time, and without indication as to
where the older ones are to be found, are of little use to most libraries
or to their readers. Like some speakers, they are too much for the
occasion.

A good bibliography can, in most cases, only be made from the books
themselves; the labor of its preparation is almost equal to that of
writing a critical history of the subject, and therefore the first question
in considering it is, Where are the books?

One session of this meeting is to be devoted to this subject of
Bibliography, which is an important one, and I hope that the papers
presented, and the discussion to follow, will bring out some valuable
suggestions. These will be especially interesting just now in view of
the fact that a Bibliographical Department has been proposed as one
of the special lines of work for the recently organized Carnegie Insti-
tion, and upon the scope and plan proposed for such a department will
no doubt depend the action of the trustees of that corporation.

A considerable part of the bibliographies which would be most use-

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261

ful for reference libraries and those engaged in research work can
only be prepared by experts in the different arts and sciences, and
there is an increasing demand for such experts in the large reference
libraries. Just now there are places for three or four well educated
engineers who have the taste and the training required to enable them
to do much needed work in the critical bibliography of their art. Every
great reference library needs half a dozen such experts in different
departments. Where are they?

In considering the questions as to the kinds of bibliographical work
the results of which would be most useful to the great majority of the
public libraries of this country and as to the means of doing such work,
it appears to me that it is best that it should be done under the direc-
tion of the Publishing Board of this Association, which has had
practical experience in this line, and will always be well informed as
to the needs of such libraries.

This opinion was brought to the attention of Mr. Carnegie, with
the suggestion that he should give to the American Library Associa-
tion a special fund, the income of which should be applied to the
preparation and publication of such reading lists, indexes, and other
bibliographical and library aids as would be specially useful in the
circulating libraries of this country. The main part of the income
would be expended in employing competent persons to prepare the
lists, indexes, etc., and to read proofs. The cost of paper and printing
would be met by sales to the libraries. It was represented that such a
gift would be wisely administered by the Publishing Board of the
Association, and that the results would be of great value in promoting
the circulation of the best books.

In response to this suggestion a check for $100,000 was sent to me
as "a donation for the preparation and publication of reading lists,
indexes, and other bibliographical and literary aids as per (your)
letter of March 14th." I shall take great pleasure in turning over this
money if the Association accepts it for the purposes and under
the conditions stated. It is a unique gift from a unique man, who de-
serves our best thanks.

To diminish or destroy desires in the individual man is the object
of one form of Oriental philosophy and of several forms of religion,
the result hoped for being the doing away with anxiety, discontent,
and fear, and the passive acceptance of what is and of what is to come.

Our work follows an opposite plan; the library aims to stimulate and
increase desire as well as to satisfy it, and the general tendency of the
free circulating library, as of public education, is to increase discon-
tent rather than to diminish it. A competent librarian will be dis-

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satisfied during most of his working hours, — he will want more books,
or more readers, or more room, or a better location, or more assis-
tants, or means to pay better salaries, or all these things together. Some
readers also will usually be dissatisfied with the library because of its
deficiencies in books, or because of some books which it has, or because
the librarian is not sufficiently attentive or is too attentive, or because
of the hours, or the excess or want of heat or ventilation, or because
of other readers. All this is an almost necessary part of the business;
if neither the librarian nor the readers are dissatisfied, the library is prob-
ably dying, or dead. But there is a discontent which is stimulating and leads
to something, and there is a discontent which is merely indicative of dis-
ease, a grumbling discontent, which resembles the muscular twitchings
which occur in some cases of paralysis. A pessimist has been defined as a
person who, having a choice of two evils, is so anxious to be right that he
takes both. Don't be a pessimist. Life is short and art is long; you can earn
your halos without making your library perfect, but halos are not to be had
by waiting for them, nor, as a rule, by hunting for them. It will make very
little difference to you fifty years hence whether you got your halo or not,
or whether it was a plain ring halo or something solid, but it may make
a great deal of difference to some of the men and women of that time,
who are now coming to your children's reading rooms, as to whether you
have deserved one or not. Each of you and each of your libraries is a thread
in the warp of the wonderful web now passing through the loom of time,
but a living thread is not altogether dependent on the shuttle of circum-
stance. It is wise to try to know something of the pattern and to guess
at some of the problems of to-morrow, but in the meantime we may
not fold our hands and wait because we do not see clearly the way we
are to go. We must do our best to meet the plain demands of to-day
bearing in mind the warning of Ecclesiastes, "He that observeth the
wind shall not sow, and he that regardeth the clouds shall not
reap. ... In the morning sow thy seed, and in the evening withhold not
thine hand, for thou knowest not which shall prosper, whether this
or that."

The Military Medical Officer at the
Opening of the Twentieth Century

I suppose that it is entirely within the bounds of possibility that some
forty or fifty years hence some member of this class will come back here
to give the address to the graduating class of that date. I am not specially
curious as to which one of you gentlemen will perform that duty, — but I
should very much like to know what he will say — if I did, I could prob-
ably make a very interesting address myself, although I might have to
make a very careful selection for fear of being thought a crank. I can
hardly imagine what Dr. McLaren, the President of the Army Medical
Board which examined me, would have thought if I had tried to answer
some of his questions as you would probably answer them. He thought
that great progress had been made since he entered the service at the
beginning of the Florida War, and that we young fellows were going into
the War of the Rebellion with great advantages. He had seen the intro-
duction of anesthesia, and was enthusiastic over the comparatively new
operations for excision of joints. He had just heard of the clinical
thermometer, but doubted whether it would be of much use, and had also
heard of the hypodermic syringe; and when he found I had one of these
instruments, he went to Surgeon General Finley (this was in 1861), and
had me assigned to duty at the hospital under his charge so that he might
see how these new things actually worked. If, however, in answering his
question as to the means of preventing malaria and typhoid fevers among
troops, I had referred to bacilli, haematozoa, flies and mosquitoes, as you
would probably do, I don't think I should have passed, and if I had
referred to antitoxin as a means of treating malignant sore throat (his
name for diphtheria), he would have advised me to take a six months'
rest in an asylum. I was asked to describe laudable pus and the best
means of securing healing by the second intention. Have any of you ever
seen any laudable pus? Certainly my knowledge of medicine in those
days before you were born was not great as compared with yours, but
when I went to the army of the Potomac I found a few doctors who knew
less, as appeared from the results of a certain examining board of which
I was a member.

When the war was over and the armies of Grant and Sherman had

Address to the graduating class of the Army Medical School at Washington, April 14,
1903. Journal of the Association of Military Surgeons of the United States 12: 349-58
(1903).

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made their last parade, when, thirty-eight years ago today, President
Lincoln was assassinated, and at last rested in the peace of death, and
the old Ford's Theatre was occupied by the Army Medical Museum and
Library, the younger medical officers in the museum became busy with
investigations, and it is interesting to remember some of the problems
which occupied them. One was the comparison of high power micro-
scopic objectives as tested on Nobert's lines; another was the best way of
making photo-micrographs; a third was the best method of staining and
mounting tissues. I clearly recollect the feelings of triumph with which 1
took some slides of stained sections of kidney and intestines mounted in
balsam to Dr. Woodward, who had been very incredulous as to the
possibility of making such preparations. Then Dr. Edward Curtis and
myself began the study of minute fungi and of Texas cattle fever, looked
for the malarial organisms on Analostan Island, and spent much time on
bacteria, following Pasteur's method. In the absence of the solid isolating
culture methods devised by Koch, we were groping blindly, but I have
not regretted the time spent in this groping. It is impossible for you to
appreciate the feelings with which we read Koch's first papers, or with
which we viewed the commencement and progress of antiseptic surgery.

When I graduated in medicine I had to write a thesis, and for divers
and sundry reasons, I chose to write on the surgical treatment of epilepsy.
I undertook to get the history of all reported cases of such treatment, and
in trying to do that I discovered that there was no library in the United
States which contained all the reports. There were no complete files of
medical journals in this country, and any man who really wanted to
write a scholarly book on medicine had to go to London or Paris for his
data. It seemed that that condition of things should be improved, and
when I came here in the Surgeon General's Office and was detailed to
settling the medical accounts of the war, I put in some side time in trying
to get this library together.

The work which was done in the old Ford's Theatre in the latter
sixties and the seventies, in connection with the Museum and Library
was in part merely incidental to the preparation of medical and surgical
history of the war, in part for the advancement of medicine, and in part
for the pleasure of the young men engaged in it. Its direct results on
the science and art of medicine were not great, but its indirect results
have been and are important. This Army Medical Museum and Library
are well known to physicians all over the world, and the opportunities
they have afforded and the aid which they have given to physicians in
the United States have been such as to produce in the medical profession
a strong interest in the Army Medical Department. It is desirable for all
parties that this interest should be maintained, and to this end the

MILITARY MEDICAL OFFICER

265

younger members of the Medical Corps should know and feel that this
Army Medical Museum and Library is an inheritance to be cared for and
increased by them for their own and the general good. One of the good
things about this Army Medical School is that it brings the Assistant
Surgeons in touch with this institution, giving it some of the features of a
central home club.

Thirty years ago there were considerable difficulties in obtaining funds
for this Institution. I look back at my experience with Congressional
appropriation committees with more amusement than I felt at the time.
At present I am told that the difficulty is to obtain the funds required to
provide shelving for the books, rather than to obtain the books. This is
also amusing.

When I asked for suggestions as to what I should talk to you about, 1
was told: — "Oh, the usual thing, congratulations and advice."

As for my congratulations, — you have them, — and they are sincere. It
is really a very fine thing to be a young army medi-officer, although there
are, occasionally, short periods of time when he may not think so: He
may have some doubts about it after he has been for a year at some small,
isolated, very healthy post, or, for a month before his examination for
promotion, or when he has to decide without advice as to what he will do
for his first case of strangulated hernia, or of incipient melancholia, or
of shot-wound of the abdomen, or of locked twins. He may even more
than doubt it when he takes a stereoscopic view of his contemplated
marriage on the one side and his salary and prospects on the other.
These doubts will pass, but as a rule he will not know clearly what a
good time he is having and what a fortunate man he is until he looks
back over his career across the gulf of twenty or thirty years.

If it is true, and I think it is, that "a spice of danger and an element of
chance add interest to work," then your work will have that interest.
You are not coming on the stage of action at the beginning of a period of
peace and content, but in the midst of a waxing tide of national struggles
for commercial supremacy and of discontent among great masses of
people. "That this turmoil and unrest can be dealt with wisely and justly,
so as to preserve that which is most desirable in civilization and in our
system of representative government, I believe, but here and there in
special localities, the immediate problems must probably be solved by
blood and steel, and that you will have a part to play in some of these is

not at all unlikely."

You will have some epidemics to face, and no doubt some of you will
have a chance to hear bullets whistle, arbitration to the contrary notwith-
standing, but the increased interest which these things may give to an
army surgeon's life is too uncertain and temporary to be worth considera-

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tion. The things most to be dreaded in your future lives are boredom
and waiting, and the preventive and remedy is to see to it that you have
something to do always, — and doing it. It may be, generally must be,
routine, like a woman's knitting work; sketching or photography, Indian
languages or calculus, infusoria or ascomycetes will any of them keep you
busy. But suggesting subjects for work is a little like the plan of the man
who told James Russell Lowell that he had discovered the way to make a
fortune. "As the fine flavor of the canvass-back is due to the wild celery
on which it feeds, I am going to feed tame ducks with it and supply the
market." Some weeks later Lowell met him and asked him how the duck
feeding plan was getting on. "Well," was the answer, "they wouldn't eat
it."

Forty years ago the microscope was mainly used by physicians as a
plaything, a source of occasional amusement. It was the correct thing for
the young graduate to buy a thirty dollar Oberhauser, and keep it in a
conspicuous place in his office, but his chief use of it was to show his
admiring friends the terrible monsters contained in a drop of selected
water.

To-day the microscope is one of our most important tools, and you have
been taught how to use it, but it may be well to remind you that you can
get a great deal of pleasure by using it in research work not directly
connected with medicine.

When you obtained your diploma as Doctor of Medicine, it is possible
that many of you thought you knew it all, or nearly all, and that what
you did not know could be found in the latest text books, monographs
and journals. Probably all of you are now aware that there are many
things in regard to the causes, prevention and treatment of disease which,
at present, nobody knows; or if any one does now, he has not told. There
is no end to the things we don't know and ought to know, and probably
will know within your lifetime.

Some of you have, perhaps, resolved that you will investigate some of
these unsettled questions, and may have even selected the particular
problem which you intend to solve. This is good, very good, but re-
member that in your life as an army medical officer the subject for in-
vestigation will usually be determined by your opportunities rather than
by your wishes. I advise every young army surgeon to have some research
work on hand for his own mental health and pleasure, just as I advise
him to take a certain amount of physical exercise, and if he cannot make
the particular research he would most like, that he try to like the research
he can make. Of course his selection of a subject for study will be largely
involuntary; if he feels a strong impulse towards some special line of
work, it is well for him to follow it, but if this work has no relation to his

MILITARY MEDICAL OFFICER

267

military duties he must bear in mind that these duties have precedence.
The fact that he is an enthusiastic botanist, ornithologist, or comparative
anatomist, is no reason whatever for his neglecting to keep himself well
informed as to advances in medical science, or not being interested in his
patients or in the sanitary condition of his post. It is also a very poor
reason why he should try to obtain posts which are specially favorable to
his particular hobby, if this hobby is not connected with military medi-
cine. If he considers his research work more important than his army
duties, he should resign from the latter.

What amount of time and energy should be given to original research
work by professional men employed in college and university work and
in Government departments is a question which has been much discussed
of late years. The exceptional man, who knows all that is known on some
one subject and has the capacity and the desire to increase knowledge on
that subject, and for whom many of our Universities and large manu-
facturing and engineering establishments are seeking, is not easily found,
and when found it is not more than an even chance that he can be
trusted to fulfill the ordinary every day duties of his profession, including
administrative work.

If any of you feel satisfied that you are that sort of man he had better
communicate with the Carnegie Institution.

Most of us hold our professional work as the first and most important
object, and original research as a thing to be done as opportunity offers.
We belong to the second class mentioned in Hesiod, i. e., those who can
understand things when explained to them.

I shall not attempt to advise you with regard to your special medical,
sanitary or surgical work, but merely ask you to remember that every
army medical officer has some special opportunities for increasing
knowledge, but that to enable him to recognize these opportunities and to
take advantage of them usually requires long study and training. It was
because of this study and training that your late teacher and friend Dr.
Walter Reed, was able to recognize his opportunity and to make the
discovery with regard to yellow fever which has placed his name high on
the roll of the famous physicians who have been great benefactors to
mankind. His work on this subject was not done under direction, rather
in spite of it, yet the line of work in which he had been engaged for the
previous ten years was what fitted him for the emergency.

These special opportunities always come to the physician, the natural-
ist, the anthropologist, they are connected with phenomena which are

occasional rarely just alike and must be secured at the time or be lost.

But you must be able to recognize them if you are to use them. Remem-

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ber the motto of the Washington City Directory "To find a name in this
book you must know how to spell it."

Permit me to say a word about your social relations and duties, which
are substantially those of the family practitioner, but with some special
peculiarities. In time of war the surgeon is more intimately associated
with line officers and their work than are the officers of other staff corps,
and to a certain extent this is also true in time of peace, and as a general
rule they are good friends. In my time there were two or three com-
manding officers who always had difficulties with medical officers, unless
they were sick, but so they did with all other officers. There were also two
or three medical officers who always had difficulties with their command-
ing officers, although they might be on very friendly terms with other
officers. These gentlemen were sensitive on questions of rank, and rights,
not so much on their own account (as they explained), as because they
felt it to be their duty to uphold the dignity of the Medical Department.
Now the nature of either personal or Departmental dignity, and the
desire to have all of one's rights, is such that the more attention you give
to them the more they seem to require, and it becomes hard to spare the
time necessary to preserve them spotless and unfrayed.

Your military rank may, on rare occasions, be an important matter
in dealing with the rank and file, but your medical skill and tact are
more important in the ordinary routine of army life.

It is your duty to contribute your quota towards the social life of your
post, and to try to make it cheerful and interesting. Of course, your
personal likes and dislikes, strength or weakness, in such matters as
athletics and games, shooting and whist, reading clubs and amateur
theatricals, the nieces of the Major's wife, and other sources of amuse-
ment, will have much influence on your actions, — but be ready to give
some of your time to things you don't care much about, if it is for the
general good and pleasure. You have got to take into consideration the
opinions, feelings and desires of some women as well as the men, but
the only piece of advice I can give on this point is, — whenever you find
yourself thinking that you thoroughly understand the ladies, — or a lady,
— at your post, you had better not prophesy.

You have also certain social duties in connection with the soldiers
under your charge. You should know them by sight and name, and you
should be interested in their individual peculiarities. And this should be
a real interest, — the soldier is quick to detect perfunctory, patronizing
forms of apparent interest. Why does Smith sulk or mope and get off by
himself as much as possible? Why has Brown suddenly become quarrel-
some? How is Jones the new recruit getting on? "These matters are the
business of the line officers," you will say. They are, but they should also

MILITARY MEDICAL OFFICER

269

interest the medical officer, who, without impertinent inquisitiveness,
and with tactful sympathy, can often make the rough path smooth, and
help his brother officer to form a wise judgment.

The medical officer may also have social and professional duties in
connection with civilians in the vicinity of his post. At a few special
places his medical services are in much demand by civilians and are paid
for, wherefore these places are desired by army surgeons. If there are
other physicians in the vicinity, and there are few places where there are
not, they may think that the army surgeon's work should be confined to
the limits of his post, and professional jealousy with a little mixture of
the Code of Ethics, has in bygone years, caused trouble to the medical
officer.

On the other hand you will find that such jealousy is the exception
and not the rule, and that if you sympathize with what interests your
professional brethren, wherever you may be, you will receive cordial
sympathy and aid from them. You are "members of a world-wide
guild, the oldest one, and the only one." The medical officer has thus a
double comradeship, and this is one of the specially attractive features of
his position.

Your attendance at this Army Medical school will have other results
besides increase of professional knowledge. You have become more or less
acquainted with each other's personality, more than you could otherwise
have done in many years, and I hope you have formed some friendships
which will endure.

Probably you will never all come together again in this life, after you
have taken your different routes over the iron lines that bind this
country to its Capital, but your paths will cross each other many times
and in unforeseen places. At each crossing may your memory of your
Washington experience aid in making the meeting a happy one.

As members of a great profession, as officers of the nation, as citizens of
a great country, as men possessing special knowledge and selected from
many candidates, you are coming on the stage of action to share the
burden and responsibility of the world's work, to bring fresh blood and
energy into the organism, to maintain and add to the dignity and honor
of your corps and of your country. Enter upon your heritage modestly,
but confidently. Be strong and of good courage. "Nos morituri saluta-
mus."

Medical Reminiscences of the Civil War

In the Fall of 1861 I went to Washington to appear before the
Medical Examining Board of the Regular Army. I had graduated from
a medical college after a two years' course, each year having exactly the
same lectures. I had had two years' hospital experience, and I had been
demonstrator of anatomy for two years, so that while I had my doubts
about my passing the ordeal of the Army Medical Board, from what I had
heard of its severity, still I thought that probably I should get through.
I came up before the Board, and at about noon of the second day I began
to feel rather comfortable and thought I was getting on very well; but by
noon of the third day there was a consultation between the examiners,
and they began all over again, going back to anatomy and to the begin-
ning of things. That went on for three days more and made me very
uneasy. I did not learn the explanation of this until long afterward. When
it was all over Dr. McLaren, the President of the Board, said to me that
he hoped I would take service at once with him — that he could not get
my commission for some time, but that I could be made a contract
surgeon without delay. I agreed to this, was introduced to Surgeon-Gen-
eral Finley, got my contract and was told that I was especially detailed
to go to the Union Hotel Hospital in Georgetown, which was under the
direction of Surgeon McLaren.

I began service, and had three things with me that none of the other
surgeons had: A set of clinical thermometers like those Dr. Keen talked
about, a straight one and one with a curve; a hypodermic syringe, and a
Symes staff for urethral stricturotomy. The hypodermic syringe was in
constant requisition. The clinical thermometer was troublesome and was
not used very much. The medical director of the army was Dr. Charles
S. Tripler, who had seen me operate for stricture of the urethra the year
before, and thought the results were very good. Consequently whenever
any surgeon of troops about Washington applied for the discharge of one
of his men for the reason that he had an impermeable stricture of the
urethra, instead of granting the discharge, Dr. Tripler sent that case to
me. There were quite a number of them, but I have no statistics of my
cases.

One day in the Spring of 1862 I was in the hospital office when two
men walked in — one a large man with an air of importance, the other a

Read April 5, 1905. Transactions of the College of Physicians of Philadelphia 27:
115-21 (1905).

270

REMINISCENCES OF THE CIVIL WAR

271

small man who had said very little. The large man said they would like
to see some of the cases in the hospital. They did not give their names,
but I thought it was proper to show the cases, and so took them around.
Practically I had done most of the operations in the hospital. After
spending about two hours they went down to the desk and the big man
said to me, "Dr. Billings, I wanted to see the man who beat my student
Adams." I told him I didn't know who "Adams" was. He said, "Don't
you know the results of your examination?" I said, "No." He then said,
"When you came up for examination they had finished their class, and
the report was just ready to go in, when you were sent over with an order
to be examined. They looked up your paper, found that you were born
in Indiana, and thought they would make short business of it. At the end
of the first day they concluded that probably you would pass, but hoped
it would not be necessary to change the order of precedence in the roll,
and that you could come in at the bottom. The second day they thought
they would have to put your name higher up, and on the third day they
concluded that you would be at the head of the class, but that, to be fair,
they ought to ask you the same questions that they had asked Dr. Adams,
who was previously the head of the class, and so they began all over again
with you. I then learned that my callers were Dr. Hammond, Surgeon-
General, and Dr. Letterman, Medical Director of the Army of the
Potomac. Dr. Hammond said to me: "Day after to-morrow all the sur-
geons in this hospital will be relieved, which will leave you in charge.
You will be sent some contract doctors, and you are to go to the cavalry
barracks at Cliffburne, on the hill back of Georgetown, turn them into a
hospital, and move this hospital out there as soon as possible."

The surgeons were relieved. I did establish the Cliffburne Hospital,
and when the wounded came in from the seven days' fighting before
Richmond I was ready for them, and had very excellent opportunities for
operative work.

I secured sixty Sisters of Charity, who took charge of the nursing side of
the work. We should not think them particularly skilled at the present
day, but they were very good for that period.

One of the difficulties at Cliffburne was that we had a large number of
Confederate as well as of Union wounded. The old residents of George-
town and Washington were mostly in sympathy with the Confederates,
and came out bringing good things to eat and drink, with the desire that
these things should be for the exclusive use of the Confederates. On the
other hand, the ladies of the families of members of Congress and of
officers in the departments were enthusiastic for the Northern side, and
they also came with various good things, but with the specification that
none should go to the rebels. We would not receive gifts from either

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JOHN SHAW BILLINGS

party on these terms, but after a little explanation they were left to be
used for those who needed them most.

I remember a member of Congress from New York City who came up
and said: "You have got a lot of my boys here; I would like to do some-
thing for them, something that the papers will notice, you know. What
do you think I had better give them?" I said: "They have all got more or
less scurvy, and I think fresh strawberries would do them good. You might
have a strawberry festival, and have a band here."

He agreed, and it was a great success, as the reporters duly proclaimed.

At the battle of Chancellorsville there was a good deal of joking among
some of our line officers about the doctors not getting up to the front, that
they kept in a comfortable place about a mile back, etc. This was mostly
chaff, but there was a little bit of earnest in it; so I said I would go up
and see. The regiment came under fire, and was then less than 200 yards
from the Confederates, and I was, perhaps, 40 yards behind the firing
line. I stopped behind a little frame house, giving notice to bring the
wounded there. I soon found that the wounded who could walk would
not stop where I was — it was entirely too close. At first the men that
were more severely hit were brought back by members of the band, but
very soon there were no more bandmen, and they never came back for a
second load. When the men began to bring their wounded fellow soldiers
in they would not stop where I was. Finally a shell went through this
wooden shanty, making a deuce of a clatter, and that settled the question
of the men stopping. The slightly wounded men would not stop, and
the bearers of the badly wounded men would not stop, so I moved back
about 200 yards and began to work there, but soon got an order from
the medical director saying that I was still too close, and must go back
to the Chancellor House about a mile away and establish my hospital
there. The next morning the Chancellor House came under artillery
fire and I had to move again. Fortunately I was able to get all the
wounded out of the house and to move them back another mile or so
into a little hollow without losing any of them. But one of my assistants
was killed.

My experience in Chancellorsville was that of handling wounded
without an ambulance corps, and getting them off when the troops were
falling back. It is one thing to provide for wounded when the troops are
advancing and leaving the hospital behind, and quite another thing to
fall back with your wounded when the troops are retreating.

Let us take another field hospital scene — this was at the battle of
Gettysburg. There I established the hospital at a farm house on the
side of Round Top, perhaps half a mile behind the first firing line. In
the house we found dough kneaded and nearly ready for the baking

REMINISCENCES OF THE CIVIL WAR

273

pans, which had even been greased. There was a fine fire in the stove,
but nobody about the house. I got my men to separate that dough into
reasonably sized lumps and slip them into the oven. Then we found a
big copper boiler which we filled with water and made coffee and some
soup. In about twenty minutes the wounded began to come in, and we
had about 850 before 12 o'clock that night. They all got hot coffee and
hot soup, but there was not enough bread to go beyond the first hundred.
The seriously wounded were in the house, and near it under the trees
and in the big barn. The slightly wounded picked their own places on
the outskirts. About midnight Dr. Letterman came in and said that he
had just learned that this particular place was going to be shelled early
in the morning, and that we should have to move on at once. I found a
place a mile to the rear, where there was plenty of water and shade,
and we began to move early in the morning. Here I had an ambulance
train and the work of moving was safely accomplished. A few shells
began to drop near as the first train of ambulances moved off, but no one
was injured.

As usually happens, about the second day it began to rain and rained
continuously for five days, and the supplies were slow in coming. Various
State auxiliary associations brought fresh bread, mutton, fruits, etc., for
their State regiments, but there were none for the regular troops. Finally
there came along a wagon from the Fire Department of Baltimore. They
said: "This is just the kind of place we want to find, that don't belong to
any State." Baltimore was rather neutral. After the wagon had been un-
loaded they informed me that they had packed one box for the surgeon.
I got the benefit of that box, and it was most judiciously packed.

Let us take another scene:

A little later, at the battle of Spottsylvania, in 1864, the Army of the
Potomac had an ambulance corps well disciplined. In that campaign I
was a medical inspector of the army, and had a chance to look around
and see what other people were doing. The first battle of the Wilderness
lasted about three days. The wounded were taken back to Fredericks-
burg, the line of the Rapidan was then abandoned and another battle
began. A large number of wounded soon resulted, but there were no
ambulances, nor had we the conveniences which the ambulances supplied.
Huts and shelters were built of cedar and pine branches, and we did
the best we could until the ambulances returned the next day. The day
was hot and sultry, the air was filled with clouds of dust, and the woods
were on fire in various places. It was hard to find water, and when found
it was warm and muddy. The medicine wagons could not be brought
up, for the roads were blocked. The surgeons worked in their shirt
sleeves, using such materials as were in the field cases, and they worked

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well — far into the night. I shall not give you any more illustrative
scenes. My general observations agree with those of Dr. Keen, that there
was not enough of operating in the state of knowledge we then had. A
very few men performed operations which were unnecessary, amputating
a few limbs which might have been saved, but the great majority were
timid and anxious to shift the responsibility and to get the simplest
dressings on as soon as possible.

During the first year of the war there was no good organization for
collecting the wounded. In the second year they had acquired the idea
that the doctor might be considered a general staff officer, and there was
an ambulance corps. In the third year there was an order issued that the
chief surgeon of the corps and the division surgeon should be at the
Division Hospital, because there they could be more easily found. The
brigade surgeons were often made the operating surgeons. The result of
this was that all the chief officers were gathered together at the Division
Hospital; and there was plenty of work for them, but the other surgeons
and assistant surgeons were without directions, and were left to exercise
their own will and pleasure, if they had any. In the case of Dr. Keen,
when he didn't get orders, he acted on his good judgment, but a good
many did not have that quality, and hence did little or nothing.

Looking back at the war as I remember it, it is a wonder that so many
of the medical officers did as well as they did, and that the results were
as good as they were. My main criticism of the surgical work which I saw
was that too much resection was attempted in cases of injury of the long
bones. If a ball smashed a femur some surgeons wanted to get out all of
the fragments, although in doing so they made the injury much more
severe.

During the first two years of the war the records of the wounded in
field hospitals were often very imperfect, for comparatively few surgeons
made notes of their cases. During the last two years of the war the
records were much more complete, as a medical officer and a hospital
steward were often detailed for the duty of making such records.

Address Given at the Opening of the
New Library Building at Radcliffe
College, Cambridge,
April 27, 1908

Whether the pleasures and satisfaction obtained in pursuit, are greater
or less than those derived from possession, is a question which has been
the subject of many unreported debates. Fifty or sixty years ago it was a
favorite subject for discussion in village and small college debating socie-
ties. It has also been the subject of a large amount of the printed literature
belonging to the departments of Sport, Fiction, Poetry, Philosophy and
Religion. Art for art's sake, and the delights of pure mathematics are
closely related to it. You will soon be in a position to form an opinion
about it, — seeing that you have had the pleasures of anticipation in the
long and strenuous efforts which have been made to secure this new
library building, and now, at last it is completed, and you can go on to
realize the plans which have been the object of your imagination and
desire. It seems to me to be very satisfactory both in its practical
arrangement and in its architectural effect.

I am specially pleased to see that the library purpose of the building
has been the only object you have had in view, in its plans and construc-
tion. Thanks to Mr. Carnegie, it has been easier in recent years to ob-
tain a library building than almost any other sort of building for colleges
in this country, and to many it has seemed quite natural and proper to
provide for as many other college needs in such a building as possible,
and, in fact, there are few of the intellectual needs of a college which
cannot be shown, at least theoretically, to depend on, or to be closely
connected with, the library.

The most important part of a library is, of course, the books, and of
these you already have a good supply, which will, no doubt, be largely
increased by the fact that you now have a suitable home for them. One
of the best mottoes for a library is "Unto him that hath shall be given."

A common method in preparing an address for an occasion like this is
to begin by saying that this new addition to your resources brings with
it increased duties and responsibilities, and then proceed to give a few
thousand words of advice. I could do this without great trouble, for I
should not be hampered with knowledge of the conditions and modes

Radcliffe Magazine 10: 107-17 (1908).

275

276

JOHN SHAW BILLINGS

of work in the college which affect the library. It is the bachelor who
advises most freely as to how a man should treat his wife, and the
spinster as to how children should be brought up.

Nearly all the eulogistic addresses about libraries which have been
printed in recent years relate to public libraries, and especially circulat-
ing libraries, intended for the use and benefit of the great mass of the
people, and in many respects do not apply to the scholars' library such
as you have here.

It would be interesting to compare this library with other college
libraries of about the same size, in order to ascertain the differences, if
any, in the character of the books, and the principles which govern their
selection. For example, does the library of a college for young men
differ from that of a college for young women, and if so, how?

Of course, every college library differs from every other college library,
depending on the character and tastes of the founders and of those who
select the books for purchase, the special purposes of the institution, the
nature of the gifts made to the library, etc. Of course, also, there are
several thousand books that will be found in every college library of ten
thousand volumes or more, including the ordinary reference books, such
as encyclopaedias, dictionaries, standard histories, biographies and fiction,
text books in the different branches of science, sets of certain periodicals,
etc., also the so-called books of power, the sacred books, works of the
great poets and dramatists, etc. But are there any considerable number
of books which will usually be found in the man's college library and
not in the woman's, or vice versa? Perhaps the college librarians who
are here to-day might contribute to the world's stock of knowledge on
this point. Mr. Gerould, librarian of the University of Minnesota, pro-
posed in 1906 a plan for the compilation of comparative university
and college library statistics1 and a committee of the American Library
Association was appointed to carry out this plan. This committee made a
preliminary report in 1907,2 but it gives no information on the question
which I have suggested.

So far as I know there is no difference between the libraries of men's
and women's colleges intended for general education only, and having
no preparatory courses for special technical instruction, but I will refer
to this later.

A library has often been compared to a laboratory for purposes of
research work. There is one likeness between them, which is seldom re-
ferred to, but to which I would call your special attention, and that is

1 Library Journal, Nov. 1906, v. 31, p. 761.

2 Papers and Proceedings of the 29th annual meeting of the American Library Associa-
tion, 1907, p. 261.

ADDRESS AT RADCLIFFE COLLEGE

277

that both are liable to become overcrowded with useless material, and to
have difficulties in the disposal of their waste products.

For a research in the laboratory special apparatus must often be ob-
tained, but when this apparatus has been used for its particular purpose,
it is often of no further value, except, perhaps, as for deposit in a museum
as a bit of history. The great majority of books lose all their vitality in
ten years, many of them never had any vitality to lose.

There is always a possibility that a book which seems useless, such as
an old City Directory, or an old text book, may be useful to some future
student, and the motive of Mrs. Toodles for buying a door-plate bearing
the name of Brown because she (Mrs. Toodles), might have a daughter,
and that daughter might marry a man named Brown "and then it would
be so handy to have that door plate in the house" is one that appeals to
some professors as well as to some librarians.

A public library necessarily accumulates much rubbish, flavorless,
namby-pamby, tedious stuff — hash without salt, which one might sup-
pose would never find a reader. But certain publishers know that there
is a demand for this sort of thing, and the librarian must remember that
he is managing a large public mental restaurant, and must be prepared
to give toast water, and broth without salt, to some of his customers,
although if they demand raw, trichinous pork, or excessively gamey birds,
he can say that his supplies of those articles have not yet arrived. I have
said that the character of a library depends on those who select the books.
When young physicians prescribe a certain diet for their patients they
are very apt to be influenced by their personal likes and dislikes, and even
an old physician with a poor digestion, (which sometimes appears in
old doctors), is sometimes too much guided by his own appetite.

Radcliffe is the only women's college I know of where all the instruc-
tion is given by men, and by men who are professors or teachers in a
University for men. Its library has been for the most part selected by
these men, each recommending the books considered as most desirable
for the student for reference work in the branch of study which he teaches.
It is, therefore, almost entirely a reference library, but is very little used
by the teachers themselves and probably contains nothing that would
not be found in a man's college library of the same size. It will accumulate
some rubbish, but slowly, unless it comes in by gifts. There is generally
a bad side to good things and this applies especially to gifts of books to
libraries, if accompanied by restrictions as to their disposal.

As the Harvard University Library is available for research purposes to
the teachers and students of this college, and as that library follows the
plan of accumulating and preserving every book or pamphlet that comes
to it and is not a duplicate, it seems clear that the policy of this library

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JOHN SHAW BILLINGS

should be to transfer its dead and dying books to Harvard to be properly
embalmed and registered.

A library may also be likened to a garden in which one may wander,
picking the flowers and fruit which seem attractive, — or in which one
may try to produce some new beauties or utilities by combinations or
eliminations of certain characters of what is already there. But the garden
must be kept properly weeded if it is to be a success, and what are weeds
for your garden may be important plants for some other.

The old army proverb that "no amount of too short bed will make a
man comfortable" applies to the library in which one cannot find the
information desired, but in many cases the book or article which the re-
search student wants has never been written, or at all events, printed. I
found this to be the case in my enquiry as to the differences between the
libraries of women's colleges and those of men's colleges to which I have
just referred.

If you do not find in your garden the special combination of pineapple
and potato which you have in mind, remember that you will probably
not find it in any garden, and that you can have the pleasure of trying to
produce it yourself and thus contribute to the joy of nations. Sometimes
too much research gives unsatisfactory results, as when you find that
the subject on which you wish to give an address has been entirely
covered by others.

The library may also be likened to a gymnasium, in that it is a place
where the intellectual and emotional faculties may be exercised and
trained. Here one may learn how to master the parallel bars of memory,
to take the long jump to conclusions, see how the world looks upside
down without being giddy, to use the flying trapeze of imagination
without bumping against too serious obstacles of fact. Here, also, one
may train and cultivate one's sense of beauty, or one's appreciation of
the funny side of life, or may compare what the wisest and best men of
all countries and of all times have thought and said about obligations
and duties, and about that which lies beyond the veil. In a large public
library one may find the materials for a course of soul massage, but
these are not needed here. As a rule they should not be used for this
purpose, at all events, before one is fifty years old. Self-hypnotization is a
dangerous business. Genuine emotion is a powerful force but it is not
wise to waste it, or to seek for means of arousing it merely as a source of
pleasure or as a means of passing the time. Emotionalism is somewhat
like alcoholism, it produces weakening or loss of the normal powers of
judgment and of will, and indicates an unbalanced nervous system,
which at first may be only slight and temporary, but which, as a habit,
may become pernicious.

ADDRESS AT RADCLIFFE COLLEGE

279

For some people the library is like the flying carpet of Arabian story,
with an improvement which enables it to transport you not only to other
countries but to other times, and even to countries and times which have
never yet existed.

The mind can travel when the body cannot, and by means of books it
can face glaciers, and deserts, and savages with impunity— it can ramble
through Rome, or lounge in the Islands of the South Pacific, — it can "go
afishing" with Walton, or Van Dyke, — it can look in at the new excava-
tions in Nippur, or Egypt, or Crete, or get a view of the Mississippi from
a pilot house with Mark Twain, or of the effects of the driver ants and
the mysteries of fetish of West Africa with Miss Kingsley, or of the shoot-
ing experiences of the "Two Dianas in Somaliland" with Agnes Herbert.
Arcady, or Atlantis, or Utopia may be viewed in an hour, — you may see
the ashes sifting down on Pompeii, or the banners waving in the lists of
the Field of the Cloth of Gold, or the black draped streets of Washington
the morning after the assassination of Lincoln, at your will and pleasure.

When I was in college fifty years ago, the Library was not recognized as
a part of the system of instruction. No professor ever referred the students
to it, or suggested any use of the books in it. It contained about 8,000
volumes, and was open on Saturday mornings from 9 to 12. Each
student could borrow two books, many of them did not borrow any, and
I always found it easy to get half a dozen or more students to give me
permission to borrow for them, so that I usually left with as many books
as I could conveniently carry.

During the long summer vacations I used to make a burglarious en-
trance into the library, and then I had long hours of enjoyment. I had
no wise librarian to guide me —I simply tried every book on the shelves,
skimming and skipping through the majority, and really reading those
which interested me, and if there had been a librarian there I should have
carefully kept away. Mr. Frederic Harrison declares that this sort of
miscellaneous reading gorges and enfeebles the intellect so that it .cannot
properly develop. On the other hand, Mr. Arthur Balfour says that Mr.
Harrison has no evidence to prove this.* "It is true no doubt that many
learned people are dull; but there is no indication that they are dull be-
cause they are learned. True dullness is seldom acquired; it is a natural
grace Fill a dull man to the brim with knowledge and he will not be-
come less dull as the enthusiasts for education vainly imagine; neither
will he become duller, as Mr. Harrison appears to suppose * But
whereas his dullness would, if left to itself, have been merely vacuous, it
may have become, under careful cultivation pretentious and pedantic.
I cannot tell whether my example supports the view of Mr. Harrison or
•The pleasures of reading, by A. J. Balfour. Edinburgh, 1888, p. 14.

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JOHN SHAW BILLINGS

of Mr. Balfour, all I can say is that my experience in the college library
has been very useful to me, and that I still skim more than three thousand
books a year to my own pleasure, if not for others' benefit.

I give this personal note in order that you may understand, and make
allowances for, the special point of view from which I am about to
consider the possible uses of this library.

When we consider what this library may, or should be to the students
of this college, — to the young women, — the ladies, — the girls, — if there
are any girls here, it seems clear that only a very few general statements
can be made.

It is intended to be a source of information on every subject in which
they should be interested, but it should also be a source of pleasure in
which every one, in any mood, can find something which will interest
her, which will seem as if it had been expressly written for her, which will
advise her when in doubt, be restful when she is tired, amuse and stimu-
late her when she is languid and bored.

No one student will require many books for all these purposes, but no
two students will want the same books, so that the library will require a
considerable stock to supply all needs.

But, the student will perhaps say, How am I to find the books I want,
when I don't even know what they are or who wrote them? How am I to
find in this wilderness garden the particular flower or fruit which will suit
me, when I may not know it when I see it? That brings up the question
of "How to use a library," a subject which ought to receive more attention
than it does in schemes of university and college instruction. A graduate
of Radcliffe ought to know what are the best reference books, encyclo-
paedias, bibliographies, anthologies, etc., and in particular those which
best serve her special needs. These are books to be used as tools, not to be
read. She ought to know how to begin a research in almost any branch
of history, literature, philosophy, or theology, and in the special branches
of science, applied science or art in which she is interested.

All these are matters in which instruction can be usefully given by
methods well known, and which are not difficult to understand. The im-
portant thing in this, as in other branches of education, is to find out how
the student can be made to want to learn about it.

Hesiod's classification of men, no doubt, applies also to the students in
this college — there are those who understand of themselves the use and
pleasure of books, there are those who can understand and appreciate
these things when they are explained to them, and there are those who
can neither understand them of themselves nor when they are explained
to them. For the first and the last of these three classes, the librarian can
do little, but for the second class it is possible to do much.

ADDRESS AT RADCLIFFE COLLEGE

281

Of course, to find a name in a directory you must know how to spell it,
and if you do not know the name of the author or the title of the book or
its subject, the quest is a little difficult. Yet, in a certain way, this indicates
a part of the information which the educated woman should have ac-
quired in the college library. She needs to know what are the hundred or
so best books for her, the books which she will wish to own and have
always with her, the books which are to be her companions and friends.
She cannot learn this from bibliographies, or from catalogues, or from
professors, she must find them out by actual trial, by continued browsing
among books old and new.

In talking with graduates of several of the leading women's colleges in
this country, I have found that they knew little about the library beyond
the particular reference and collateral reading books which they had
used. They did not seem to have wandered about the library testing
and tasting a book here and there. They said when they were in the
library they had no time for anything but reference work, and that for
their own leisure reading in their rooms, they got books from other
libraries. They did not know whether the library contained any books
specially intended for women, or not.

This seemed to me to indicate something lacking somewhere, but
whether it was in the girl, or in the character of the books in the college
library, or in the methods used to induce the students to use the library,
I do not know.

I have alluded to the fact that no differences seem to exist between the
libraries of colleges for men and of those for women. To use the words
of a librarian of a women's college, "There is no flavor of the exclusively
feminine attaching itself to the library of a women's college any more
than to the curriculum." (This is not from Bryn Mawr.) So far as the
literature relating to the curriculum is concerned, this may be well, but
when it comes to providing browsing ground where the girls may find
out what are the books which they want for their very own, it seems
possible that a little flavor of the exclusively feminine might be desirable.

I should like to see in every college library a browsing corner, not
arranged according to decimal, or the progressive, or any other system of
classification, which should be what Mr. Balfour describes as a "peaceful
desert of literature as yet unclaimed by tutors or coaches, where it might
be possible for the student to wander, even perhaps to stray, at her own
pleasure without finding every beauty labelled, every difficulty engineered,
every nook surveyed."

This browsing corner should contain no book associated with memories
of study, and no book recommended by any professor for reference or for
collateral reading. I could make some suggestions for a few of these

282

JOHN SHAW BILLINGS

books for a man's college, — such as books on sport, or travels with a large
sporting element, or life in the woods, the history of Flatland, Montaigne,
the history of magic of Eliphas Levi, Lavengro and the Romany Rye, a
set of Punch, and Puck, etc.

For the browsing corner of the women's college library I think it wise
to make no specific suggestions, but I should place in it a few of the best
illustrations of the taste of women at different times and in different
countries in matters of applied art.

According to the catalogue of this library it contains no book on lace,
or on tapestry, but I would admit a few books of this kind to the brows-
ing corner, which should also contain a special selection of biographies
and fiction and of the latest poetry. I should give the students an
opportunity of seeing in the browsing corner, some of the newest books,
and for this purpose the method adopted in some clubs seems a good one.
For example, in the Century Association of New York, there are always
six of the latest books on the table. These books are furnished by sub-
scription to a circulating library, and are changed every two weeks. One
of them is usually a novel, the others are books of travel, and sport,
essays, biographies, etc., books that are being noticed in the daily and
weekly press; they are much used but seldom read through.

A lady of great experience in library management to whom I men-
tioned this browsing corner idea, highly approved of it and went on to
suggest that two or three rocking chairs and an upholstered window seat
with plenty of sofa pillows would improve it. I think they would.

In his book on the private library4 Mr. Humphreys has a section of
"Boudoir libraries," which begins, "Women have their own way of
loving books." This is probably true, just as they have their own way (in
several senses) about most things. The greater part of this section is
devoted to the bindings which are appropriate for a boudoir library and
closes with an essay "On my lady's library," given in the Spectator. I
suppose you all remember it. Elsewhere he says that every bedroom should
have a bookcase, and that housemaids are seldom bibliophiles.

If I only knew what books, or what kinds of books, each of you will
have in her own library twenty-five years from now, I could prepare an
address which would be of great interest to historians and sociologists.
But I can only say that the character of your private libraries will depend
much on the manner in which you have used this library.

Owing to the wide diffusion of public library facilities, and perhaps for
other reasons, men do not now accumulate books for their private use to
the extent that they used to do. They do not, as a rule have as much affec-

4 Humphreys, Arthur L. The Private Library. What we do know, what we don't
know, what we ought to know about our books. N.Y. Post., 1897.

ADDRESS AT RADCLIFFE COLLEGE

283

tion for their books, they have not given as much time, and trouble, and
sacrifice to obtain certain books as their grandfathers did. Dr. Oliver
Wendell Holmes used to say that there was an invisible thread connect-
ing each book in his library with his heart and brain, and that it was
cruel to ask him to part with any of his treasures merely because they
would be more useful in a general library.

I have said little about the practical utilities of books or of libraries. In
this library are gathered the most important records of the world's
memory, of the progress of man from the days when Accad ruled the
land between the rivers and the first dynasty was building in the valley
of the Nile.

The dreams and hopes, the joys and sorrows, the sayings and doings of
the wisest men of all times and of all countries are gathered here, and it is
from these that our teachers, our legislators and our people must draw
the stores and weapons with which to contend with the same ignorance,
indolence, folly and vice which have led to the downfall of the kingdoms
and cities of long ago. "In this library there are also suggestions as to
beautiful and as to unpleasant things in this world of which it is difficult
to see the use. Of such are the Aurora, and the hidden anemone which
no one sees, and the grief for the loss of a dear one, mother or child.
There is no unit of measure for the utility of these things," but they are
necessary.

I have no doubt that you have all heard of the "Philobiblon" of Rich-
ard de Bury and some of you have read this eloquent appeal for the
collection and preservation of books. He says "We must consider what
pleasantness of teaching there is in books, how easy, how secret! How
safely we lay bare the poverty of human ignorance to books without
feeling any shame! They are masters who instruct us without rod or
ferule, without angry words, * * * if you come to them they are not
asleep; if you ask and enquire of them, they do not withdraw them-
selves * * * They do not laugh at you if you are ignorant."

"O books, who alone are liberal and free * * * ye are the wells of living
waters * * * the most delightful ears of corn, full of grain; * * * fig trees
that are never barren, lamps always in readiness."

It should be observed, however, that the learned bishop meant these
eulogies chiefly for old books or what he calls "the well tested labours
of the Ancients," of whom he says that "whether they had by nature a
greater vigour of mental sagacity, or whether they perhaps indulged in
closer application to study * * * one thing we are pretty clear about, that
their successors are barely capable of discussing the discoveries of their
forerunners."

We have no list of the large collection of books and manuscripts which

284

JOHN SHAW BILLINGS

he made, but it is probable that very few of them would be read if they
were in our libraries, and I think this would also apply to a considerable
number of the hundred best books named by Lord Acton. We can, all of
us, however, join in the eulogy of de Bury, with the simple qualification
that for us it applies to our books, the books which we know and love.

It is, perhaps, well that in your student life you should not be oppressed
by too' keen a sense of the responsibilities which will weigh upon you as
women in the coming years. These responsibilities will relate mainly to
what you can and should do for the benefit of others. Much of what you
are now learning in order to pass examinations will, for most of you, be
soon forgotten because you will have no occasion to use it, but the
sources of this information and the methods of finding and using these
sources you will not forget. If you have acquired in this library the
knowledge as to what books interest you, it will be one of the most im-
portant benefits which you can derive from your college course.

Bibliography of the Writings of
John Shaw Billings

1861

1. The surgical treatment of epilepsy. Cincinnati Lancet and Observer
4: 334-41 (1861).

1863

2. Cliffburne Hospital, Washington, D. C. (Extract from a report).

Medical and surgical history of the War of the Rebellion. Third
medical volume, p. 910. (1888).

1865

3. Letter to Col. Thomas A. McParlin, Medical Director Army of the

Potomac transmitting the statistics of sick and wounded of the
Army of the Potomac for 1864. Dated Washington City, June 17,
1865. Rebellion records, ser. I, v. 42, pt. 1, pp. 202-3.

4. Report on the treatment of diseases and injuries in the Army of the

Potomac during 1864. Medical and surgical history of the War of
the Rebellion. First medical volume. Appendix, pp. 199-202.
(1870; Second issue, 1875).

1869

5. Report of results of examinations of fluids of diseased cattle with

reference to presence of cryptogamic growths. By Brevet Lieuten-
ant Colonel J. S. Billings and Brevet Major Edward Curtis. U. S.
Department of Agriculture. Reports on the diseases of cattle in
the United States. Washington, 1869. pp. 156-70.
5A Army medical organization. [Correspondence; signed A. B. C.].
Medical Record (NY) 3: 572-8 (15 Feb 1869). Reprinted in
Military Surgeon 99: 40-50 (1946) [with annotations by Colonel
Harold W. Jones].

Prepared by Adelaide R. Hasse of the New York Public Library and originally
published as Appendix III, pp. 411-22, of Fielding H. Garrison's John Shaw Btlhngs;
a memoir (New York, Putnam, 1915). The listing in the Index Catalogue, 2d series has
been compared. The item numbers assigned by Miss Hasse have been retained; addi-
tional items have been indicated by following letters.

285

286

JOHN SHAW BILLINGS

1870

6. A report on barracks and hospitals; with descriptions of military

posts. Washington, 1870. 494 p. (U. S. Surgeon General's Office.
Circular No. 4).

6A. The Marine Hospital Service. [Unsigned editorial]. Medical Times
(Phila) 1: 97 (15 Dec 1870).

1871

6B. The medical and surgical history of the late war, and the report of
the Surgeon-General for 1870. [Unsigned editorial]. Medical Rec-
ord (NY) 5: 493-4 (2 Jan 1871).

6C. The annual report of the Surgeon-General, and the medical and
surgical history of the war. [Unsigned editorial]. Medical Times
(Phila) 1: 118-9 (2 Jan 1871).

6D. Microscopical memoranda, by Dr. Newlenz [Correspondence].
Medical Times (Phila) 1: 200 (1 Mar 1871).

7. The study of minute fungi. American Naturalist 5: 323-9 (1871).

8. The genus Hysterium and some of its allies. American Naturalist

5: 626-31 (1871).

1872

9. On some minute fungi. (Abstract of a paper read February 5, 1872).

Bulletin of the Philosophical Society of Washington 1: 42-3
(1871-4).

1873

10. On the collection of a large library. (Abstract of a memoir pre-

sented December 6, 1873). Bulletin of the Philosophical Society
of Washington 1: 92-3 (1871-4).

1874

11. Abstract of special reports by Army medical officers on the effect of

mountain climates upon health. (Read at annual meeting, Phila-
delphia, November 12, 1874). Public Health Reports and Papers,
American Public Health Association 2: 148-50 (1874-5).

1875

12. Notes on hospital construction. (Read at annual meeting, Phila-

delphia, November 10, 1874). Public Health Reports and Papers,
American Public Health Association 2: 384-8 (1874-5).

13. A bibliography of cholera. U. S. Congress. House. The cholera

BIBLIOGRAPHY

287

epidemic in the United States. Washington, 1875. (43 Cong, 2d
Sess: House Ex. Doc. 95). pp. 707-1025.

14. Remarks on medical topography. (Read at the annual meeting in

Baltimore, November 10, 1875). Public Health Reports and Pa-
pers, American Public Health Association 2: 47-54 (1874-5).

15. A report on the hygiene of the United States Army; with descrip-

tions of military posts. Washington, 1875. 567 p. (U. S. Surgeon
General's Office. Circular No. 8).

16. Hospital construction and organization. Hospital playis, Johns Hop-

kins Hospital, Baltimore. New York, 1875. pp. 3-46.

17. Report of Committee on the Plan for a Systematic Sanitary Survey

of the United States. (Submitted at the annual meeting in Balti-
more, November 10, 1875). Public Health Reports and Papers,
American Public Health Association 2: 41-6 (1874-5).

1876

18. A century of American medicine, 1776-1876; literature and institu-

tions. American Journal of the Medical Sciences 72: 439-80 (1876)
Also in: A century of American medicine, 1776-1876. Philadel-
phia, H. C. Lea, 1876. pp. 289-366.

19. (Johns Hopkins Hospital.) Reports and papers relating to construc-

tion and organization. Nos. 1-3, 5. Baltimore, 1876-8. (No. 5:
Report on heating and ventilation. 1878. 93 p.).

20. Medical libraries in the United States. U. S. Department of the

Interior. Bureau of Education. Public libraries in the United
States of America; their history, condition, and management;
special report. Part I. Washington, 1876. pp. 171-82.

21. The rights, duties, and privileges of the community in relation to

those of the individual in regard to public health. (Address at the
annual meeting in Boston, October 5, 1876). Public Health
Reports and Papers, American Public Health Association 3: 49-52
(1875-6).

1877

22. Bacteria and spontaneous generation. (Abstract of communication.

February 10, 1877). Bulletin of the Philosophical Society of
Washington 2: 109-10 (1874-8).

23. On the plans for the Johns Hopkins Hospital at Baltimore. (A

lecture given to the medical profession of Baltimore, February 5,
1877). Part I. Medical Record (NY) 12: 129-33 (24 Feb 1877).
Part II. Medical Record (NY) 12: 145-8 (3 Mar 1877).

24. [Course of lectures on the history of medicine, medical legislation

288 JOHN SHAW BILLINGS

and medical education given by Dr. Billings at the Johns Hop-
kins University in the Autumn of 1877]. (Outline). Larkey, S. V.
John Shaw Billings and the history of medicine. Bulletin of the
Institute of the History of Medicine 6: 360-76 (1938). Appendix,
pp. 373-6.

25. Medical education; extracts from lectures delivered before the

Johns Hopkins University, Baltimore, 1877-8. Baltimore, W. K.
Boyle & Son, 1878. 42 p. Reprinted in Bulletin of the Institute of
the History of Medicine 6: 311-59 (1938); also Bulletin of the
Johns Hopkins Hospital 62: 323-71 (1938).

1878

25 A. Higher medical education. (Review). American Journal of the
Medical Sciences 76: 174-89 (1878); Reprinted in Bulletin of the
Institute of the History of Medicine 6: 287-310 (1938); also
Bulletin of the Johns Hopkins Hospital 62: 299-322 (1938).

26. Suggestions with regard to incorporating in the approaching United

States Census statistics of diseases as well as of deaths. (Trans-
mitted to the Hon. S. S. Cox, M. C, Chairman Committee on
Census of 1880, by Surgeon-General, United States Army. October
15, 1878). Washington, 1878. 2 1. Reprinted in Public Health
Reports and Papers, American Public Health Association 4: 373-5
(1877-8).

26A. National catalogue of medical literature. Library Journal 3: 107-8
(1878).

1879

27. Introduction on hygiene. Including: I. Prefatory remarks. II. Causes

of disease. III. Jurisprudence of hygiene. Buck, A. H. (ed.).
Treatise on hygiene and public health. New York, William Wood
&: Co., 1879. Vol. 1, pp. 1-70. [Buck's Treatise was published
also, with separate title page, as volume 18 of von Ziemssen's
Cyclopedia of the practice of medicine. New York, William
Wood & Co., 1879.]

28. Report of the Committee charged with making a sanitary survey of

Memphis, Tenn. Annual Report of the National Board of Health,
1879. pp. 237-62; 1880, pp. 416-41.

29. Address in state medicine and public hygiene. Transactions of the

American Medical Association 30: 275-91 (1879).

30. The medical journals of the United States. Boston Medical and

Surgical Journal 100: 1-14, 108 (1879).

31. The study of sanitary science. Plumber (NY) 2: 125 (1878-9).

BIBLIOGRAPHY

289

1880

32. The National Board of Health and national quarantine. Trans-

actions of the American Medical Association 31: 435-55 (1880).

33. Report of Committee on the Nomenclature of Diseases and on

Vital Statistics; J. S. Billings, Chairman. Annual Report of the
National Board of Health, 1880. pp. 537-94.

34. Report on sanitary survey of Memphis, Tenn. Annual Report of

the National Board of Health, 1880. pp. 602-17.

35. Remarks on the sanitary condition of Memphis. Proceedings and

Addresses at the Sanitary Convention held at Detroit, Michigan,
1880. pp. 69-72.

36. The President's address at the Eighth Annual Meeting of the

American Public Health Association, New Orleans, December 7,
1880. Public Health Papers and Reports, American Public Health
Association 6: 1-11 (1880).

37. The report of the Advisory Council on National Sanitary Legisla-

tion. Public Health Papers and Reports, American Public Health
Association 6: 385-401 (1880).

38. The scientific work carried on under the direction of the National

Board of Health. (Abstract of remarks. November 20, 1880).
Bulletin of the Philosophical Society of Washington 4: 37-9
(1880-1).

39. The National Board of Health. Plumber (NY) 3: 47, 273 (1879-80).

40. National health legislation on trial. (Review). American Journal of

the Medical Sciences 78: 471-9 (1879). Also in Sanitarian 7: 50 1 —
10 (1879-80).

41. The organization and operation of the National Board of Health.

Medical Record (NY) 17: 101-3 (1880).

42. Who founded the National Medical Library? (Letter) Medical

Record (NY) 17: 298-9 (1880).

43. Letters to a young architect on ventilation and heating. Plumber

(NY) 3: 132, 154, 171, 191, 211, 233, 251, 271, 291, 311, 331, 351,
371, 392, 415, 432, 463 (1879-80); continued in Sanitary Engineer
4: 8, 37, 68, 83, 110, 131, 155, 180, 203, 228, 253, 274, 305, 329,
470, 496, 536, 554 (1880-1); 5: 6, 99, 266 (1881-2); 6: 369, 492
(1882); 7: 6, 122, 219, 339, 434, 602 (1882-3); 8: 523 (1883). [Re-
printed as no. 62, infra.].

44. Yellow fever. International Review (NY) 8: 29-49 (1880).

1881

45. Our medical literature. Transactions of the International Medical

Congress (1th, London, 1881). Vol. 1, pp. 54-70. Also in British

290

JOHN SHAW BILLINGS

Medical Journal 2: 262-8 (1881). Lancet 2: 265-70 (1881). Boston
Medical and Surgical Journal 105: 217-22 (1881). Revue Scien-
tifique de la France 29: 586-96 (1882). Geneeskundige Courant
35: 44_8 (1881). Vrachebniya Vaidomosti 6: 2534, 2559, 2573,
2594 (1881). Norsk Magazin for Laegevidenskaben 12: 141-66
(1882).

46. The experience of the United States in recent years with regard to

Asiatic cholera and yellow fever. Transactions of the Interna-
tional Medical Congress (1th, London, 1881). Vol. 4, pp. 416-28.

47. Mortality statistics of the Tenth Census. Transactions of the Ameri-

can Medical Association 32: 297-303 (1881).

48. Patents on ventilating apparatus. Sanitary Engineer 4: 327 (1880-1).

1882

48A. The International Medical Congress. International Review (NY)
12: 1-10 (January, 1882).

49. The registration of vital statistics. Annual Report of the National

Board of Health, 1882. pp. 355-461.

50. The registration of vital statistics in the United States. National

Board of Health Bulletin 3: 295 (1881-2).

51. On the ventilation of the House of Representatives. (Abstract of

remarks. April 8, 1882). Bulletin of the Philosophical Society of
Washington 5: 99-100 (1881-2).

52. The information necessary to determine the merits of the heating

and ventilation of a school building. Circular of Information of
the Bureau of Education (Washington). No. 2, 1882. pp. 11-19.

53. Notes on military medicine in Europe. Journal of the Military Serv-

ice Institution of the United States 3: 234-47 (1882).

54. The vaccination question. Nation (NY) 34: 201-2 (1882).

55. House sanitation in large cities. Sanitary Engineer 5: 338 (1881-2).

56. Address to the graduating class of Bellevue Hospital Medical Col-

lege. (Delivered March 15, 1882). Medical News (Phila) 40: 285-8
(1882).

1883

57. Medical bibliography. Transactions of the Medical and Chirurgical

Faculty of Maryland, 1883. pp. 58-80.

58. The heating and ventilation of a school building. Sanitary Engineer

7: 317 (1882-3).

59. Germs and epidemics. Sanitary Engineer 7: 341, 387 (1882-3).

60. Papers on vital statistics. Sanitary Engineer 8: 418, 442, 488, 541,

588 (1883); 9: 15, 163 (1883-4); 11:9, 80, 128, 249 (1884-5).

BIBLIOGRAPHY

291

1884

61. The World's Industrial and Cotton Centennial Exposition, New

Orleans, La., 1884-5. (Medical Department, United States Army,
Exhibit Class 4, Nos. 5-7.) New Orleans, 1884. No. 5. Description
of selected specimens from the medical and surgical sections of
the Army Medical Museum, at Washington, D. C. 20 p. No. 6.
Description of the microscopes and microscopical preparations
from the Army Medical Museum, Washington, D. C. 15 p. No. 7.
Description of the composite photographs of crania, and of
crania from the Army Medical Museum, Washington, D. C. 15 p.

62. The principles of ventilation and heating and their practical appli-

cation. New York, The Sanitary Engineer, 1884. 216 p. London,
Trubner & Co., 1884. 226 p. [Reprinted from No. 43, supra.].

63. Composite photography applied to craniology. (Abstract of com-

munication. March 29, 1884). Bulletin of the Philosophical So-
ciety of Washington 7: 25-6 (1884).

64. [Report of resolutions in memory of Joseph Janvier Woodward with

abstract of remarks on Dr. Woodward's work, etc.] November 8,
1884. Bulletin of the Philosophical Society of Washington 7:
75-6 (1884).

65. The mortality rates of Baltimore; life tables for Baltimore; mor-

tality in different wards; causes of disease. Maryland Medical
Journal 10: 487-9 (1883-4).

1885

66. Methods of tabulating and publishing records of deaths. Public

Health Papers and Reports, American Public Health Association
11:51-66 (1885).

67. On composite photography as applied to craniology, by J. S. Bill-

ings, and On measuring the cubic capacity of skulls, by Wash-
ington Matthews. (Read April 22, 1885). Memoirs of the National
Academy of Sciences 3: 105-16 (1886) 20 pi.

68. On a new craniophore for use in making composite photographs

of skulls. By John Shaw Billings and Washington Matthews.
(Read November 12, 1885). Memoirs of the National Academy
of Sciences 119 (1886) 4 pi.

69. Memoir of Joseph Janvier Woodward. National Academy of Sci-

ences. Biographical memoirs, v. 2, 1886. pp. 295-307.
70 Report on the mortality and vital statistics of the United States as
returned at the Tenth Census (June 1, 1880). Washington,
1885-6. 3 v. (United States Census Office, Rep. 10'ft Census, v.

292 JOHN SHAW BILLINGS

11-12). [Text] v. 1. 1885. lxiii, 767 p. [Text] v. 2. 1886. clviii,
803 p. [Plates, v. 3] xvii, 19 pi., 20 maps, 38 diag.

71. Sewage disposal in cities. Harper's Magazine 71: 577-84 (1885).

71 A. Hygiene. Pepper, William. A system of practical medicine. Vol. 1,
Pathology and general diseases. Philadelphia, Lea, 1885. pp. 173-
212. [cf. No. 112, infra.].

1886

72. Scientific men and their duties. (The President's address before the

Philosophical Society of Washington, December 4, 1886.) Bulletin
of the Philosophical Society of Washington 9: xxxv-lvi (1886-7).

73. On museum specimens illustrating biology. (Abstract of communi-

cation presented at 288"J meeting of the Philosophical Society of
Washington, May 22, 1886). Bulletin of the Philosophical Society
of Washington 9: 35-6 (1886-7).

74. Medicine in the United States, and its relation to co-operative in-

vestigation. (The annual address in medicine delivered before the
British Medical Association, August 11, 1886). British Medical
Journal 2: 299-307 (1886). Medical News (Phila) 49: 169-80

(1886) .

75. Hot water and steam compared. Sanitary Engineer 14: 595 (1886).

1887

76. Effect of freezing on the typhoid germ. Sanitary Engineer 15: 211

(1886-7).

77. Methods of research in medical literature. Transactions of the

Association of American Physicians 2: 57-67 (1887). Boston Medi-
cal and Surgical Journal 116: 597-600 (1887).

78. On some forms of tables of vital statistics, with special reference to

the needs of the health department of a city. Public Health Papers
and Reports, American Public Health Association 13: 203-23

(1887) .

1888

79. Medical museums, with special reference to the Army Medical

Museum at Washington. Medical News (Phila) 53: 309-16 (1888).

80. The history of medicine. Introductory lecture (to a course of eight

lectures delivered before the Lowell Institute of Boston). Boston
Medical and Surgical Journal 118: 29-31, 57-60 (1888).

81. The Medical College of Ohio before the war. Address to the So-

ciety of the Alumni of the Ohio Medical College, delivered at the

BIBLIOGRAPHY

293

Annual Commencement, March 7, 1888. Cincinnati Lancet-Clinic
20: 297-305 (1888).

1889

82. On vital and medical statistics. The Cartwright lectures delivered

before the Alumni Association of the College of Physicians of
New York in November, 1889. Medical Record (NY) 36: 589, 617,
645 (1889).

83. The plans and purposes of the Johns Hopkins Hospital. Medical

News (Phila) 54: 505-10 (1889).

84. The United States Census in its relations to sanitation. Public

Health Papers and Reports, American Public Health Association
15: 43-6 (1889) [Discussion, pp. 243-6].

85. Water supply for small towns. Engineering and Building Record

19: 235 (1888-9).

86. House drainage from various points of view. Popular Science

Monthly 34: 310-24 (1888-9).

87. Biographical memoir of Spencer Fullerton Baird. (Read before the

National Academy of Sciences, April 17, 1889). National Academy
of Sciences. Biographical memoirs, v. 3, 1895. pp. 141-60.
87A. Rare medical books. (Remarks at the meeting of the Johns Hop-
kins Hospital Medical Society, December 16, 1889). Bulletin of
the Johns Hopkins Hospital 1: 29-31 (1890).

1890

88. Description of Johns Hopkins Hospital. Baltimore, I. Friedenwald,

1890. 116 p., 56 pi. (Johns Hopkins Hospital Publications).

89. The national medical dictionary. Edited by John Shaw Billings.

Philadelphia, Lea, 1890. 2 v.

90. Vital statistics of the Jews in the United States. Washington, 1890.

19 p. (U. S. Bureau of the Census. IIth Census. Bulletin No. 19.)

91. The relations of the physicians of the United States to the next

census. Journal of the American Medical Association 14: 641-3
(1890).

1891

92. Ideals of medical education. (Address delivered before the Medical

Faculty of Yale College, June 23, 1891). Boston Medical and
Surgical Journal 124: 619-23; 125: 1-4 (1891). New Englander &
Yale Review 19: 111-32 (1891).

93. [Can the reports of the sick and the sanitary statements of the

different armies be arranged according to a scheme essentially

294

JOHN SHAW BILLINGS

uniform for the purpose of gaining statistics of scientific worth
for comparison of diseases, wounds and deaths in times of peace
and war?] (Text in English). V erhandlungen des X internation-
alen medicinischen Congresses, Berlin, 4-9 August 1890. Berlin,
1891. Band 5, 18 Abtheilung, pp. 107-34.

94. American inventions and discoveries in medicine, surgery and prac-

tical sanitation. Boston Medical and Surgical Journal 124: 349-51
(1891).

95. A field hospital at Gettysburg. Youth's Companion, July 2, 1891;

p. 373.

96. Modern surgery. Youth's Companion, October 15, 1891; p. 547.

97. Public health and municipal government. Philadelphia, 1891. 23 p.

(Supplement to Annuls of the American Academy of Political and
Social Sciences, 1891).

98. Social statistics of cities. Washington, 1891. 27 p. (U. S. Bureau of

the Census. IP" Census. Bulletin No. 100).

99. Mechanical methods used in compiling data of the 11** United

States Census; with an exhibition of a machine. (Abstract).
Proceedings of the American Association for the Advancement
of Science 40: 407-9 (1891).

100. The conditions and prospects of the Library of the Surgeon-Gen-

eral's Office, and of its Index-Catalogue. Transactions of the
AssociatioJi of American Physicians 6: 251-7 (1891). Boston Medi-
cal and Surgical Journal 125: 344-6 (1891). Medical News (Phila)
59: 350-3 (1891).

101. Vital statistics of the Jews. North American Review 153: 70-84

(1891).

1892

102. Addresses delivered before the Mutual Aid Association of the

Philadelphia County Medical Society for the Relief of the Widows
and Orphans of Medical Men, December 14, 1892. By Drs.
Billings, Keen, and Willard, and George D. McCreary, Esq.
[Philadelphia] 1892. 11 p.

103. The health of survivors of the war. Forum (NY) 12: 642-58 (1892).

104. The objects, plans, and needs of the Laboratory of Hygiene. An

address delivered at the opening of the Laboratory of Hygiene of
the University of Pennsylvania, Feb. 22, 1892. Medical News
(Phila) 60: 230-6 (1892); also as Extracts, Boston Medical and
Surgical Journal 126: 181-4 (1892).

105. St. Augustine: Report upon her present sanitary condition. New

York, J. B. Watkins, 1892. 7 p.

BIBLIOGRAPHY

295

106. A syllabus of the lectures on hygiene, vital statistics, etc., at the

University of Pennsylvania. By John Shaw Billings and Alexander
C. Abbott. Edited by Seneca Egbert. Philadelphia, Collins, 1892.
29 p.

107. The causes of outbreaks of typhoid fever. Medical News (Phila)

61: 601 (1892).

108. Prevalence of consumption in the United States. Transactions of

the New York Academy of Medicine 9: 35-7 (1892).

109. How Tom kept bachelor's hall. Youth's Companion, November 10,

1892; pp. 598-9.

110. In a draft office. Youth's Companion, November 17, 1892; p. 610.

1893

111. A condensed statement of the requirements of the principal univer-

sity medical schools in Europe with regard to candidates for the
degree of Doctor of Medicine. Baltimore, privately printed, 1893.
25 1.

112. Hygiene. Pepper, William. A text-book of theory and practice of

medicine. Vol. 1, 1893, pp. 1-45. [cf. No. 71A, supra].

113. Photomicrographs of normal histology, human and comparative,

prepared by direction of the Surgeon-General. By John Shaw
Billings and William M. Gray. Washington, 1893. 2 p., 76 photo.
113A. The human bones of the Hemenway collection in the United
States Army Medical Museum at Washington. By Dr. Washington
Matthews, [and] with observations on the hyoid bones of this
collection, by Dr. J. L. Wortman. Reports presented to the Na-
tional Academy of Sciences with the approval of the Surgeon-
General of the United States Army, by Dr. John S. Billings.
Memoirs of the National Academy of Sciences 6: 141-286 (1893)
59 pi. [Statement by Billings, pp. 141-2].

114. World's Columbian Exposition, Chicago, III., 1892-3. (War Depart-

ment Exhibit. Medical Department, United States Army). Chi-
cago, 1893. No. 5. Description of microscopes from the Army
Medical Museum, Washington, D. C. 6 p. Description of selected
specimens from the Army Medical Museum, Washington, D. C.
14 p.

115. Vital statistics of the District of Columbia and Baltimore covering a

period of six years ending May 31, 1890. Washington, 1893. 241 p.,
12 coloured maps. (U. S. 52d Congress. 1st Session. House Misc.
Doc. 340, Part 8).

116. The relation of hospitals to public health. Hospitals, dispensaries

and nursing. Papers and discussions in the International Con-

296 JOHN SHAW BILLINGS

gress of Charities, Correction and Philanthropy, section Hi, June
12th to 17th, 1893. Edited by John S. Billings, M. D., Henry M.
Hurd, M. D. Baltimore, 1894. pp. 1-7. Also in Lend a Hand
(Boston) 11: 168-75 (1893).

117. The population of the earth. Chautauquan 16: 527-30 (1892-3).

118. Effects of his occupation upon the physician. International Journal

of Ethics 4: 40-8 (1893).

119. Municipal sanitation defects in American cities. Forum (NY) 15:

304-10 (1893).

120. Medicine as a career. Forum (NY) 14: 725-34 (1893).

121. Ventilation and heating. New York, The Engineering Record, 1893.

500 p.

122. Municipal sanitation in Washington and Baltimore. Forum (NY)

15: 727-37 (1893).

123. Municipal sanitation in New York and Brooklyn. Forum (NY) 16:

346-54 (1893-4).

123A. Hospital Historical Club. Rare book. (Symphorien Champier).
Bulletin of the Johns Hopkins Hospital 4: 99-100 (1893). [". . .
Dr. Kelley exhibited the following book and accompanying note
upon it by Dr. J. S. Billings of Washington"].

123B. The city's health. Dr. Billings explains the plan of the Sanitary
League. The Evening Star (Washington), March 15, 1893.

123C. The city's health. Vital statistics for different sections of Washing-
ton. The Evening Star (Washington), November 18, 1893.

1894

124. Bibliography [preliminary) of the literature on the physiological

and pathological effects of alcohol and alcoholic drinks. Edited
for the Committee of Fifty for the Investigation of the Liquor
Problem. Washington, Judd &: Detweiler, 1894. 28 p.

125. Hygiene in university education. Address given to the University

Extension Classes, Oxford, Engl., Aug. 7, 1894. Boston Medical
and Surgical Journal 131: 125-31 (1894).

126. The bacteria of river waters. Presenting a paper on the bacteria of

the Schuylkill River by Dr. J. H. Wright. Memoirs of the Na-
tional Academy of Sciences 7: 419-21 (1894).

127. The influence of certain agents in destroying the vitality of the

typhoid and of the colon bacillus. By John Shaw Billings and
Adelaide Ward Peckham. Annual Report of the Board of Regents
of the Smithsonian Institution to the Congress of the United
States, 1894. pp. 451-8. Also in Science 1: 169-74 (1895).

128. The influence of light upon the bacillus of typhoid and the colon

BIBLIOGRAPHY

297

bacillus. Presenting results of an investigation by Adelaide W.
Peckham. Read April 19, 1894. Memoirs of the National Academy
of Sciences 7: 477-82 (1894).

129. Methods of teaching surgery. Boston Medical and Surgical Journal

130: 535-8 (1894).

130. On the influence of insolation upon culture media and of dessica-

tion upon the vitality of the bacillus of typhoid, of the colon
bacillus, and of the Staphylococcus pyogenes aureus. (Presented
October 30, 1894). Memoirs of the National Academy of Sciences
7: 483-4 (1894) 5 color pi.

131. Vital statistics of New York City and Brooklyn, covering a period of

six years ending May 31, 1890. Washington, 1894. 529 p., 12
maps. (U. S. 53d Congress. 1st Session. House Misc. Doc. 340,
Part 13).

132. [Remarks, meeting of the Harvard Medical Alumni Association,

June 26, 1894.] Boston Medical and Surgical Journal 131: 140-2
(1894).

133. Compulsory notification of tuberculosis. Philadelphia Polyclinic 3:

73 (1894).

134. A report on the etiology and vital statistics of diphtheria and

croup. Presented on behalf of the American Committee to the
Eighth International Congress of Hygiene and Demography at
Buda-Pesth. British Medical Journal 2: 578-9 (1894).

135. Water supply and sewage disposal in some large European cities.

Engineering and Building Record 30: 395-7 (1894); also in Food
(NY) 5: 187-96 (1894-5).

136. The health of Boston and Philadelphia. Forum (NY) 17: 595-602

(1894).

136A. John Arderne and early English medical writers. (Read before the
Hospital Historical Club, February 12, 1894). Bulletin of the
Johns Hopkins Hospital 5: 21-2; 67 (1894). ["Dr. Billings spoke
... he showed a manuscript volume of the works of John Arderne,
recently acquired by the Library of the Surgeon-General's Office,
through Mr. Thomas Windsor . . . The following memorandum by
Mr. Windsor gives what is known of his life . . ."].

1895

137. The composition of expired air and its effects upon animal life.

By }. S. Billings, S. Weir Mitchell, and D. H. Bergey. Washington,
1895. 81 p. (Smithsonian Contributions to Knowledge, v. 29, No.
989).

138. The history and literature of surgery. System of surgery. Edited by

298 JOHN SHAW BILLINGS

Frederic S. Dennis, assisted by John S. Billings. Philadelphia, Lea,
1895.4v. Vol. l,pp. 17-144.

139. Municipal mortality statistics. University Medical Magazine (Phila)

7: 721-9 (1894-5).

140. Report of the Committee appointed by the Smithsonian Institution

to award the Hopkins Fund Prizes. August 9, 1895. S. P. Langley,
G. Brown Goode, J. S. Billings, and Mark W. Harrington. Annual
Report of the Board of Regents of the Smithsonian Institution
to the Congress of the United States, 1895. p. 13.

141. Report on the insane, feeble-minded, deaf and dumb, and the blind

in the United States at the Eleventh Census, 1890. Washington,
1895. 755 p., 86 pi. (Also as: U. S. 52d Congress. 1st Session.
House Misc. Doc. 50, Part 16).

142. Report on the social statistics of cities in the United States at the

Eleventh Census, 1890. Washington, 1895. 137 p., 33 diagr. (U. S.
52d Congress. 1st Session. House Misc. Doc. 340, Part 19).

143. Suggestions to hospital and asylum visitors. With an introduction

by S. Weir Mitchell. By John Shaw Billings and Henry M.
Hurd. Philadelphia, Lippincott, 1895. 48 p.

144. Vital statistics of Boston and Philadelphia, covering a period of six

years ending May 31, 1890. Washington, 1895. 229 p., 12 maps.

145. Waste. Address on Commencement Day at Miami University, Ox-

ford, Ohio, June 20, 1895. Oxford, 1895. 19 p.

146. The William Pepper Laboratory of Clinical Medicine. Address

given at the opening of the Laboratory, December 4, 1895.
[Philadelphia, 1895]. 15 p.

147. A card catalogue of scientific literature. Science 1: 406-8 (1895).

148. Degeneration, by Max Nordau. [Review]. Science 1: 465-7 (1895).

149. The climates and baths of Great Britain. [Review]. Science 2: 454-5

(1895).

149A. The world's debt to medicine. Chautauquan 20: 668-72 (March
1895).

149B. The world's debt to modern sanitary science. Chautauquan 21:
18-23 (April 1895).

1896

149C. Medical statistics. A system of medicine. Edited by Thomas Clif-
ford Allbutt. New York, Macmillan. Vol. 1, 1896. pp. 3-20. [Re-
printed 1901; the Billings essay does not appear in the second
edition, 1905].

150-1. Report on vital and social statistics in the United States at the
Eleventh Census, 1890. Washington, 1894-6. Parts 1-4. (U. S. 52d

BIBLIOGRAPHY

299

Congress. 1st Session. House Misc. Docs., v. 50, pt. 18). Part 1.
Analysis and rate tables. 1896. 1059 p. Part 2. Vital statistics.
Cities of 100,000 population and upward. 1896. 1181 p. Part 3.
Statistics of deaths. 1894. 1050 p. Part 4. Statistics of deaths.
1895. 1033 p.

152. See no. 168A.

152A. [International catalogue of scientific works; letter of Simon New-
comb and John S. Billings to the Secretary of State, October 15,
1896]. The Smithsonian Institution; documents relative to its
origin and history. Vol. 2. Washington, 1901. pp. 1770-1.

1897

153. The influence of the Smithsonian Institution upon the development

of libraries, the organization and work of societies, and the
publication of scientific literature in the United States. Smith-
sonian Institution, 1846-1896; the history of its first half century.
Washington, 1897. pp. 815-22.

154. Some ideas in hospital construction. Report made to the Memphis

City Council upon plans proposed for the new city hospital.
Memphis Medical Monthly 17: 193, 249, 309 (1897).

1900

155. Progress of medicine in the nineteenth century. Annual Report of

the Board of Regents of the Smithsonian Institution to the Con-
gress of the United States, 1900. pp. 637-44.

1901

156. The card catalogue of a great public library. Library Journal 26:

377-83 (1901).

157. [Address at the dedication of the new building of the Boston Medi-

cal Library, January 12, 1901]. Boston Medical and Surgical
Journal 144: 61-3 (1901).

1902

158. Biographical memoir of Francis Amasa Walker, 1840-1897. (Read

before the National Academy of Sciences, April 17, 1902). Na-
tional Academy of Sciences. Biographical memoirs, v. 5, 1902. pp.
209-18.

159. Some library problems of tomorrow. (President's address to the

American Library Association, June 17, 1902). Library Journal
27, no. 7: 1-9 (1902).

300

JOHN SHAW BILLINGS

1903

160. The military medical officer at the opening of the twentieth century.
(Address to the graduating class of the Army Medical School at
Washington, April 14, 1903). Journal of the Association of Mili-
tary Surgeons of the United States 12: 349-58 (1903).

161-2. Physiological aspects of the liquor problem. By W. O. Atwater,
J. S. Billings, H. P. Bowditch, R. H. Chittenden, and W. H.
Welch. Boston, Houghton, Mifflin & Co., 1903. 2 v. V. 1, pp. 307-
38: Data relating to the use of alcoholic drinks among brain
workers in the United States. V. 1, pp. 339-55: Relations of drink
habits to insanity.

163. The public library; its uses to the municipality. Library Journal

28: 293-4 (1903).

1904

164. A discussion of the vital statistics of the Twelfth Census. Wash-

ington, 1904. 24 p. (United States Census Bureau, Bulletin 15).

165. The Carnegie Institution. Journal of the American Medical Asso-

ciation 42: 1674-5 (1904).

1905

166-7. The liquor problem; a summary of investigations conducted by
the Committee of Fifty, 1893-1903. By J. S. Billings, C. W. Eliot,
and others. Boston, Houghton, Mifflin 8c Co., 1905. 182 p. Pp.
15-42: A summary of investigations concerning the physiological
aspects of the liquor problem.

168. Medical reminiscences of the Civil War. Transactions of the College

of Physicians of Philadelphia 27: 115-21 (1905).

1906

168A. The king's touch for scrofula. Proceedings of the Charaka Club
2: 57-71 (1906).

1908

169. Address given at the opening of the new library building at Rad-

cliffe College, Cambridge, April 27, 1908. Radcliffe Magazine 10:
107-17 (1908).

1911

170. Public library systems of greater New York. Library Journal 36:

489-92 (1911).

171. The New York Public Library. Century (NY) 81: 839-52 (1911).

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